Los Angeles, CA asked in Personal Injury and Medical Malpractice for California

Q: falsely attributing records to fake individuals for hospice fraud

Hospital engaged in fraud and falsely attributing records to fake individuals - for referral to hospice. What statute defines liability for falsely attributing records to fake individuals?

2 Lawyer Answers

A: In addition to statutes outline by my colleague, it's possible that additional statutes could apply, such as those involving identity theft. Good luck

James L. Arrasmith
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Answered

A: In California, falsely attributing medical records to fake individuals as part of a hospice fraud scheme could potentially violate several statutes. Two key laws that may apply are:

1. California Penal Code Section 470 - Forgery

This law makes it a crime to falsely make, alter, forge, or counterfeit documents with the intent to defraud. Creating fake medical records attributed to non-existent people would likely qualify as forgery under this statute.

2. California Penal Code Section 550 - Insurance Fraud

This statute prohibits various forms of health insurance fraud, including:

- Knowingly presenting false or fraudulent claims for payment of a health care benefit

- Knowingly preparing, making, or subscribing to any writing, with the intent to present it in support of a false or fraudulent claim

- Knowingly making or causing to be made any false or fraudulent claim for payment of a health care benefit

Falsely attributing hospice records to fake patients in order to fraudulently bill insurers or government health programs like Medicare/Medicaid would almost certainly constitute insurance fraud under Section 550.

Other potentially relevant laws include identity theft statutes if real people's identities are used, and the federal False Claims Act if the fraud targets federal healthcare programs.

But in summary, California Penal Code Sections 470 (forgery) and 550 (health insurance fraud) are two of the key state laws that criminalize falsely attributing medical records to fake individuals as part of a hospice fraud scheme. The exact charges would depend on the specific facts of the case.

Tim Akpinar agrees with this answer

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