The Office of the District Attorneys Economic Crimes Unit is responsible for prosecuting medical insurance fraud for cases in which the dollar loss exceeds $100,000. These cases are vertically prosecuted. Smaller loss cases are prosecuted in the regional branch courts.
Medical insurance fraud is a problem that spreads the cost to everyone. Fraudulent claims increase the cost of health insurance for everyone and affect all of us through higher premiums. Medical insurance fraud can take many forms and includes fraud by patients, medical providers and insurers or insurance company insiders.
If you are approached to obtain unnecessary treatment for a bonus or commission, remember that this is a violation of Penal Code 550 (insurance fraud) and Insurance Code 750 (unlawful referrals). You can be punished after conviction by up to five years in state prison, a $10,000 fine, and be forced to repay the stolen amount. Penal Code 550 (a)(6) prohibits making any false or fraudulent claim to a health insurance provider.
