Los Angeles, CA asked in Health Care Law for California

Q: Legally Actionable Fraud.

Hospital referred patient to hospice with non-existent terminal disease, recorded on admission to hospital.

Legally actionable fraud was committee by both hospital and hospice?

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1 Lawyer Answer
James L. Arrasmith
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Answered

A: Under California law, legally actionable fraud requires the following elements:

1. A misrepresentation of a material fact

2. Knowledge of the falsity of the misrepresentation (or reckless disregard for its truth)

3. Intent to induce reliance on the misrepresentation

4. Justifiable reliance by the plaintiff

5. Resulting damage

Based on the limited information provided, it's difficult to definitively say whether legally actionable fraud occurred in this situation. However, here are some key considerations:

- If the hospital knowingly and falsely claimed the patient had a terminal illness when admitting them, and this false information was used to refer the patient to hospice care, that could potentially constitute a misrepresentation of material fact.

- It would need to be shown that the hospital made this false claim with the intent of inducing the patient's reliance on it in agreeing to hospice care. Simply an incorrect diagnosis would likely not rise to the level of fraud.

- The patient (plaintiff) would need to show they justifiably relied on the hospital's misrepresentation in agreeing to hospice care. If they had access to information contradicting the terminal diagnosis, that could undermine a fraud claim.

- The patient would need to demonstrate damages resulting from the alleged fraud, such as unnecessary medical expenses, pain and suffering, etc.

Whether the hospice provider could also be liable for fraud would depend on their knowledge of the situation. If they were aware the terminal diagnosis was false but admitted the patient anyway, they could potentially share liability.

Ultimately, more facts would be needed to properly evaluate the viability of a fraud claim here. Medical malpractice may be another relevant legal theory to explore. An experienced attorney would need to review all the details to determine the best path forward. Fraud claims involving healthcare providers can be quite complex.

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