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

Q: torts law

What torts law defines healthcare fraud?

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: In California, healthcare fraud is primarily addressed under the state's False Claims Act and the Insurance Frauds Prevention Act.

The California False Claims Act (CFCA) is a civil law that allows the state government and private citizens to file lawsuits against individuals or entities that knowingly submit false claims for payment to the state, including false claims related to healthcare services. This law is similar to the federal False Claims Act and covers a wide range of fraudulent activities, such as:

1. Billing for services not provided

2. Upcoding (billing for a more expensive service than the one actually provided)

3. Unbundling (billing separately for services that should be billed together at a lower rate)

4. Billing for medically unnecessary services

The Insurance Frauds Prevention Act (IFPA) is a criminal law that specifically targets insurance fraud, including healthcare insurance fraud. This law makes it a crime to knowingly present false or fraudulent claims for payment of a healthcare benefit, or to knowingly prepare or make any written or oral statement as part of a plan to defraud a healthcare insurance program.

Both the CFCA and IFPA are powerful tools in combating healthcare fraud in California. They provide for significant penalties, including fines and potential imprisonment for those found guilty of violating these laws. Additionally, the CFCA allows private citizens to bring lawsuits on behalf of the state (known as qui tam actions) and share in any recovered funds, creating a strong incentive for individuals to report suspected fraud.

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.