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Medi-Cal Fraud Statutes (Criminal)

CODE SECTION DESCRIPTION PENALTY
WELFARE & INSTITUTIONS CODE 14014 (False Declaration as to Eligibility) - Person receiving or encouraging another to receive health care - For which he or she was not eligible
- On the basis of false declarations
Felony or misdemeanor, depending on amount of fraud under guidelines of Penal Code section 487 (over $400 felony)
WELFARE & INSTITUTIONS CODE
14107

(Fraudulent Claims)
- Present claim for payment
- With intent to defraud
- For goods or services
- To obtain greater compensation than legally entitled
- Knowing the information is false
Misdemeanor - one year county jail and $1,000 fine.
Felony - 2, 3, or 5 years and fine not exceeding three times the amount of fraud or improper reimbursement or value of scheme or artifice.
If the execution of a scheme or artifice to defraud is committed under circumstances likely to cause or that do cause two or more persons great bodily injury, or serious bodily injury, a term of four years, in addition and consecutive to the term of imprisonment imposed, shall be imposed for each person who suffers great bodily injury or serious bodily injury.
WELFARE & INSTITUTIONS 14107.2(a)
(Kickbacks, Bribes or Rebates)
- Solicits or receives any kickback, bribe or rebate to either:
- Refer or promise to refer person for service or merchandise
- Purchasing, leasing or ordering service or merchandise
Misdemeanor - one year county jail and $1,000 fine.
Felony - 16 months, 2 years, 3 years and $10,000 fine. (Second offense - straight felony)
WELFARE & INSTITUTIONS CODE
14107.2(b)

(Kickbacks, Bribes or Rebates)
- Offer to pay any kickback, bribe or rebate to either:
- Refer or promise to refer person for service or merchandise
- Purchasing, leasing or ordering service or merchandise
Misdemeanor - one year county jail and $1,000 fine
Felony - 16 months, 2 years, 3 years and $10,000 fine. (Second offense - straight felony)
PENAL CODE 487
(Grand Theft)
- A person takes the property of another
- With specific intent to deprive permanently
- Took or carried away property
Misdemeanor - one year county jail and $1,000 fine.
Felony - 16 months, 2 years, 3 years and $10,000 fine
PENAL CODE 550(a)(5)
(Prepare or Make a False Writing)
Knowingly prepare, make, or subscribe any writing with intent to present or use it in support of any false or fraudulent claim Felony or misdemeanor, depending on amount of fraud under guidelines of Penal Code section 487 (over $400 felony).
Misdemeanor - One year county jail and $1,000 fine.
Felony - 2, 3, or 5 years state prison plus $50,000 fine or double the amount of fraud, whichever is greater
PENAL CODE 550(a)(6) (Making a False Claim) Knowingly make or cause to be made any false or fraudulent claim for health care benefit Felony or misdemeanor, depending on amount of fraud under guidelines of Penal Code section 487 (over $400 felony).
Misdemeanor - One year county jail and $1,000 fine.
Felony - 2, 3, or 5 years state prison plus $50,000 fine or double the amount of fraud, whichever is greater
PENAL CODE 550(a)(7) (Submitting a False Claim) Knowingly submit a claim for a health care benefit which was not used by or on behalf of the claimant Felony or misdemeanor, depending on amount of fraud under guidelines of Penal Code section 487 (over $400 felony).
Misdemeanor - One year county jail and $1,000 fine.
Felony - 2, 3, or 5 years state prison plus $50,000 fine or double the amount of fraud, whichever is greater

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