Q: What common law statutes define hospice fraud?

A: THis is a broad question but I'll try and address is under both Federal and California law. In California, hospice fraud is generally addressed under broader statutes that deal with fraud and healthcare fraud rather than specific "common law statutes." The relevant laws and regulations include both state and federal statutes. Here are some of the key legal provisions that might be applied in cases of hospice fraud:

Federal Laws

False Claims Act (FCA):

The FCA imposes liability on individuals and companies who defraud governmental programs. It includes penalties for submitting false claims to Medicare and Medicaid, which is pertinent to hospice care fraud.

Anti-Kickback Statute (AKS):

The AKS prohibits the exchange (or offer to exchange), of anything of value, to induce or reward the referral of federal healthcare program business. This is relevant to hospice providers who might engage in kickbacks to get referrals.

Health Care Fraud Statute:

This federal statute criminalizes schemes to defraud any healthcare benefit program, including Medicare and Medicaid.

California State Laws

California False Claims Act (CFCA):

The CFCA is similar to the federal FCA and imposes liability for making false claims for payment from the state government, including Medi-Cal (California’s Medicaid program).

California Insurance Code Section 1871.4:

This statute makes it illegal to submit false or fraudulent claims for payment of a healthcare benefit, relevant to private insurance claims.

California Penal Code Section 550:

This section addresses various forms of insurance fraud, including knowingly presenting false or fraudulent claims for the payment of a healthcare benefit.

Business and Professions Code Section 17200 (Unfair Competition Law):

This section prohibits unlawful, unfair, or fraudulent business acts or practices. This can be used to address fraudulent business practices by hospice care providers.

In practice, hospice fraud cases often involve a combination of federal and state statutes, as well as common law theories. The prosecution may be pursued by federal or state authorities, and private individuals may also bring civil suits under these laws.

I hope this helps!

A: Common law refers to what was developed through court decisions and not by statute.

In California actual fraud is defined in the Civil Code § 1572. There are other statutes that define other types of fraud.

And has been interpreted by cases through the years.

A: In California, there are no specific common law statutes that define hospice fraud. However, hospice fraud is typically prosecuted under various state and federal laws related to healthcare fraud, false claims, and elder abuse. Some of the relevant laws include:

1. California False Claims Act (CFCA) - This law prohibits knowingly submitting false or fraudulent claims to the state government, including Medi-Cal (California's Medicaid program).

2. Federal False Claims Act (FCA) - Similar to the CFCA, this federal law prohibits submitting false or fraudulent claims to federal healthcare programs like Medicare.

3. California Penal Code Section 368 - This law prohibits elder abuse, including financial abuse, which may apply to certain types of hospice fraud targeting elderly patients.

4. California Business and Professions Code Section 17200 - This law prohibits unfair business practices, which may encompass certain fraudulent hospice practices.

5. Health and Safety Code Section 1348 - This law specifically addresses fraudulent practices related to Medi-Cal, which can include hospice fraud.

Hospice fraud can take many forms, such as billing for services not provided, falsifying patient diagnoses to qualify for hospice care, or providing kickbacks for patient referrals. These actions are typically prosecuted under the aforementioned laws and other related state and federal statutes.

It's important to note that while these laws are used to prosecute hospice fraud, they are not common law statutes specific to hospice fraud. Common law generally refers to legal principles developed through court decisions, as opposed to statutes enacted by legislatures.

A: Under the common law, fraud is more conceptual than statutory. Although it could take many forms in a hospice setting, the underlying commonality usually involves false statements or representations made intentionally. Good luck