california medical clinic duty to report patient fraud

Report it. The Department of Health Care Services (DHCS) asks that anyone suspecting Medi-Cal fraud, waste, or abuse to call the DHCS Medi-Cal Fraud Hotline at 1-800-822-6222. If you feel this is an Emergency please call 911 for immediate assistance. The call is free and the caller may remain anonymous.

Full Answer

Can a doctor commit Medi Cal fraud?

Welfare & Institutions Code 14107 focuses on Medi-Cal fraud committed by medical practitioners (such as doctors, psychotherapists, physical therapists, pharmacists, etc.). Example: Samantha is a doctor who is authorized as a Medi-Cal provider. She employs Michael, an unlicensed medical assistant, to work in her office.

How do I report Medi-Cal fraud?

The Department of Health Care Services (DHCS) asks that anyone suspecting Medi-Cal fraud, waste, or abuse to call the DHCS Medi-Cal Fraud Hotline at 1-800-822-6222.

What is the sentence for Medi-Cal fraud in California?

The potential felony prison sentence for most forms of Medi-Cal fraud is anywhere from sixteen (16) months to five (5) years. Felony fines can go up to fifty thousand dollars ($50,000), or double or triple the amount of the fraud. 7 There is insufficient evidence to support the charges. 1. Legal Definition of Medi-Cal Fraud in California 1.1.

What is Medi-Cal fraud?

“Medi-Cal fraud” is a fraud that is committed in connection with California’s Medi-Cal program. Medi-Cal is a state program that provides free or low-cost health coverage to children and adults with limited income and assets. 1 Medi-Cal fraud has elements of both health care fraud and welfare fraud. A man applies for Medi-Cal benefits.

What is the financial burden of Medi-Cal fraud?

For those needing health care services, Medi-Cal fraud means the loss of already scarce funds to pay for vital services.

Is Medi-Cal fraud a violation of the False Claims Act?

Unnecessary; Not performed; More costly than those actually performed. Medi-Cal fraud also refers to paying and/or receiving kickbacks for Medi-Cal billing referral s, and violations of the California False Claims Act and other related state laws. Based on government and private studies, and on the hundreds of millions of dollars ...

What is Medi-Cal fraud?

Simply put, Medi-Cal fraud is any instance of California insurance fraud that has California’s Medi-Cal program as a “victim.”. Medi-Cal is a program of free or low-cost health coverage for Californians. Groups that may receive Medi-Cal benefits include:

What are the other crimes that can be charged with Medi-Cal fraud?

Other California offenses that may be charged along with or instead of Medi-Cal fraud include: 4.1. Elder abuse. Penal Code 368 PC, California’s elder abuse law, makes it a crime to willfully or negligently impose unjustifiable physical pain and/or mental suffering on a person who is 65 or older. 42.

How long is the prison sentence for Medi-Cal fraud?

This means that they may be charged as either misdemeanors or felonies in California law. 6. The potential felony prison sentence for most forms of Medi-Cal fraud is anywhere from sixteen (16) months to five (5) years.

Does the Attorney General investigate Medi-Cal fraud?

This explains why the California Office of the Attorney General is very motivated to investigate and prosecute Medi-Cal fraud cases. In fact, the Attorney General has established a specialized Bureau of Medi-Cal Fraud and Elder Abuse.

How does fraud affect health insurance?

It affects everyone—individuals and businesses alike—and causes tens of billions of dollars in losses each year. It can raise health insurance premiums, expose you to unnecessary medical procedures , and increase taxes. Health care fraud can be committed by medical providers, patients, and others who intentionally deceive ...

How to protect health insurance information?

Protect your health insurance information. Treat it like a credit card. Don't give it to others to use, and be mindful when using it at the doctor’s office or pharmacy. Beware of “free” services. If you're asked to provide your health insurance information for a “free” service, the service is probably not free and could be fraudulently charged ...

What is the DEA's documentary about the life of an opiate addict?

To combat the growing epidemic of prescription drug and heroin abuse, the FBI and DEA released Chasing the Dragon: The Life of an Opiate Addict, a documentary aimed at educating students and young adults about the dangers of addiction. Learn more at fbi.gov/chasingthedragon.

What is the FBI?

The FBI is the primary agency for investigating health care fraud, for both federal and private insurance programs. The FBI investigates these crimes in partnership with: Insurance groups such as the National Health Care Anti-Fraud Association, the National Insurance Crime Bureau, and insurance investigative units.

Is prescription fraud a crime?

Prescription Medication Abuse. Creating or using forged prescriptions is a crime, and prescription fraud comes at an enormous cost to physicians, hospitals, insurers, and taxpayers. But the greatest cost is a human one—tens of thousands of lives are lost to addiction each year.

Who can file a complaint against a health care facility?

Anyone can file a complaint against a health-care facility -- a patient or facility resident, a relative or friend, even a general member of the public.

How long does it take to file a complaint in a hospital?

Complaint investigations involving general acute care hospitals and other non-long-term care facilities must be completed within 45 days if the allegation indicates an ongoing threat of imminent danger of death, or serious bodily harm.

What is PCB in CHCQ?

The Investigation Section of CHCQ's Professional Certification Branch (PCB) investigates complaints against the health-care facility professionals that we license or certify. The section's information page, "How to Report Misconduct or Abuse," details PCB's complaint processes and other frequently asked questions.

How to file a complaint against a company?

Please complete and submit the Complaint Form (CDPH 318). You may also write a complaint by providing the following, if known: 1 Name, address, and telephone number of the subject of complaint 2 Facility/Employer name and address of the subject of complaint 3 If different, name and address of incident location 4 Date, time, and details of the allegation, including names and witnesses and victims involved 5 Name, address, and telephone number of the reporting party/complainant

What information is needed to be confidential in a civil case?

It is important to provide specific details, including dates and times, list of witnesses or contacts, as well as any documentary evidence. If a complainant “confidentially” provides his or her name, address or telephone number, the Department cannot guarantee anonymity if the case goes to hearing.

Can a mandated reporter be convicted of a crime in California?

Yes. Under California law, mandated reporters who fail to report known or suspected instances of abuse, neglect, misappropriation, unprofessional conduct, etc. are guilty of a crime.