Q: Cal. Health and Safety code sections that define liability for fraud

A: Under California law, there are several statutes within the California Health and Safety Code that define liability for misrepresentation, concealment, and fraud by healthcare organizations and doctors. Here are the relevant sections:

1. Cal. Health & Safety Code § 1320.5 - Misrepresentation in Obtaining Health Care Services

This section makes it unlawful for any person to knowingly and willfully make or cause to be made any false or fraudulent claim for payment of a health care benefit. It also prohibits knowingly submitting false information for the purpose of obtaining greater compensation than that to which the person is legally entitled.

2. Cal. Health & Safety Code § 1320.6 - Concealment in Obtaining Health Care Services

This section makes it unlawful for any person to knowingly and willfully execute, or attempt to execute, a scheme or artifice to defraud any health care benefit program or to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any health care benefit program.

3. Cal. Health & Safety Code § 1320.7 - False or Fraudulent Claims

This section makes it unlawful for any person to knowingly present or cause to be presented any false or fraudulent claim for the payment of a loss or injury, including payment of a loss or injury under a contract of insurance. It also prohibits knowingly preparing, making, or subscribing any writing, with the intent to present or use it, or to allow it to be presented, in support of any false or fraudulent claim.

These sections apply to healthcare organizations and doctors, making it illegal for them to engage in misrepresentation, concealment, or fraud in relation to health care services and benefits. Violations of these statutes can result in criminal penalties, civil fines, and potential disciplinary action against medical licenses.

It's important to note that this is just a summary of the relevant sections, and the full text of the statutes should be consulted for a complete understanding of the law. Additionally, other state and federal laws, such as the California Insurance Frauds Prevention Act and the federal False Claims Act, may also apply in cases of healthcare fraud.