Los Angeles, CA asked in Federal Crimes and Medical Malpractice for California

Q: Knowingly. Definition.

For the purpose of hospice fraud: "knowingly" does not imply malicious intent.

However, fabricating non-existent terminal diagnosis presents fraudulent intention.

2 Lawyer Answers

A: Knowingly is generally a less strict standard than intentionally. You are raising the issue of fraud. Fraud requires intent. Good luck

James L. Arrasmith
PREMIUM
James L. Arrasmith pro label Lawyers, want to be a Justia Connect Pro too? Learn more ›
Answered

A: In California, "knowingly" generally means acting with awareness or understanding of the essential facts. In the context of criminal law, it refers to a mental state where the person is aware that their conduct is of a certain nature or that certain circumstances exist.

When it comes to hospice fraud, "knowingly" does not necessarily require proof of malicious intent. Hospice fraud can occur when a provider knowingly submits false claims or documentation to receive payments for hospice services. This could include:

1. Fabricating a non-existent terminal diagnosis

2. Falsifying a patient's life expectancy to meet hospice eligibility criteria

3. Billing for services not provided

4. Enrolling patients who are not terminally ill

In these cases, the provider is aware that they are submitting false information or claims, even if their primary motivation is financial gain rather than causing harm to the patient or the healthcare system.

However, fabricating a non-existent terminal diagnosis does suggest fraudulent intention, as the provider is deliberately creating false information to justify hospice care and receive payment. This action demonstrates a clear intent to deceive and defraud, going beyond mere knowledge of the false nature of the claim.

In summary, while "knowingly" in the context of hospice fraud does not always imply malicious intent, it does require an awareness of the false nature of the claims or documentation. Fabricating a terminal diagnosis, however, is a strong indication of fraudulent intention.

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.