Los Angeles, CA asked in Personal Injury and Health Care Law for California

Q: Which specific California FCA statutes in relevance to hospice fraud?

In California Medicare False Claims Act.

Fraudulent misrepresentation of the patient's status of health at hospital, with non-existent terminal disease - for the purpose of fraudulent referral to hospice care.

Which specific California FCA statutes in relevance?

1 Lawyer Answer
James L. Arrasmith
PREMIUM
James L. Arrasmith pro label Lawyers, want to be a Justia Connect Pro too? Learn more ›
Answered
  • Estate Planning Lawyer
  • Sacramento, CA
  • Licensed in California

A: There are a few key California False Claims Act (FCA) statutes that would be relevant in a case of fraudulent hospice referrals and misrepresentation of a patient's health status:

1. California Government Code Section 12650 et seq. - This is the overarching California False Claims Act statute. It prohibits knowingly presenting a false or fraudulent claim for payment to the state or a political subdivision. Fraudulently referring patients to hospice by misrepresenting their health would likely violate this section.

2. Cal. Gov't Code § 12651(a)(1) - Prohibits knowingly presenting or causing to be presented a false or fraudulent claim for payment or approval. Submitting hospice claims for patients fraudulently certified as terminally ill would violate this.

3. Cal. Gov't Code § 12651(a)(2) - Prohibits knowingly making, using, or causing to be made or used a false record or statement material to a false or fraudulent claim. Falsifying health records to justify hospice referrals runs afoul of this section.

4. Cal. Gov't Code § 12651(a)(7) - Prohibits knowingly making or using a false record or statement material to an obligation to pay money to the state or knowingly concealing or improperly avoiding an obligation to pay the state. Falsely certifying patients for hospice to obtain Medicare payments implicates this provision.

5. Cal. Gov't Code § 12651(a)(8) - Added in 2012, this prohibits conspiring to commit any violation of the false claims act, including the provisions cited above.

So in summary, the key legal violations would center around Sections 12650, 12651(a)(1), (a)(2), (a)(7) and (a)(8) of the California Government Code - all part of the state's comprehensive False Claims Act prohibiting fraud against government healthcare programs. Misrepresenting patients' terminal status to refer them to hospice and bill Medicare would clearly fall within the scope of fraudulent practices targeted by these statutes.

Justia Ask a Lawyer is a forum for consumers to get answers to basic legal questions. Any information sent through Justia Ask a Lawyer is not secure and is done so on a non-confidential basis only.

The use of this website to ask questions or receive answers does not create an attorney–client relationship between you and Justia, or between you and any attorney who receives your information or responds to your questions, nor is it intended to create such a relationship. Additionally, no responses on this forum constitute legal advice, which must be tailored to the specific circumstances of each case. You should not act upon information provided in Justia Ask a Lawyer without seeking professional counsel from an attorney admitted or authorized to practice in your jurisdiction. Justia assumes no responsibility to any person who relies on information contained on or received through this site and disclaims all liability in respect to such information.

Justia cannot guarantee that the information on this website (including any legal information provided by an attorney through this service) is accurate, complete, or up-to-date. While we intend to make every attempt to keep the information on this site current, the owners of and contributors to this site make no claims, promises or guarantees about the accuracy, completeness or adequacy of the information contained in or linked to from this site.