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Health Care and Insurance Fraud


Health care and insurance fraud can take many forms, but one of the most common involves people receiving benefits they shouldn’t or charging services that weren’t provided. Whether you are being accused of making false statements to receive medical benefits and kickbacks through health care claims – or even have been charged with the illegal possession and use of medications or medical equipment, you need legal advice from an experienced Santa Barbara health care insurance fraud attorney.

Read more below to learn:

  • Santa Barbara Health Care and Insurance Fraud Law

  • What the PROSECUTION Has To Prove In Order To Get A Conviction

  • Ways to Defend Against Health Care and Insurance Fraud Charges

  • Health Care and Insurance Fraud Penalties and Types of Fraud

  • Real-Life Example for Health Care and Insurance Fraud Charges

  • Contacting a Health Care and Insurance Fraud Lawyer For Immediate Help

Healthcare fraud can take many forms and can affect us, in one way or another. Charges under Insurance Code Section 1871.4 and Penal Code Section 550 focus on the person submitting the insurance claim making false statements to either obtain or deny the insurance benefits. Since these alleged false statements are then being used to get health insurance benefits, the person accused could possibly face what is called perjury, under Penal Code Section 118. Essentially, perjury is the intentional act of swearing in a false oath or even falsifying an affirmation to tell the truth.

Importance of a Santa Barbara Health Care and Insurance Fraud Attorney.

These claims call for immediate action in contacting an experienced Santa Barbara County Health Care and Insurance Fraud Attorney.

The law says that in order to get a conviction for health care insurance fraud, criminal court must be able to prove beyond a reasonable doubt that you were involved in two (2) things: First, someone must have committed fraud by lying about certain aspects of the healthcare, and second, you or the person in question knew about it. Prosecutors need to convince a jury that both these elements are true.

Let’s look at each one separately.

This is what the PROSECUTION has to prove in order to get a conviction:

First, the prosecution has to show that someone lied about certain aspects of your healthcare—like saying they did or didn’t perform a medical procedure when they really did or didn’t. This may seem straightforward, but there are several different ways you can commit fraud related to your own healthcare. For example, an overbilling scheme involves billing patients for services not rendered or at rates higher than what was agreed upon with Medicare or private insurers. Meanwhile, upcoding means doctors bill insurers for more serious diagnoses than what’s been confirmed through diagnostic tests like MRIs and X-rays—which can result in greater reimbursement from Medicare or private insurers.

You may be tangled in this either through the medical center you work for or through being a patient. Either way, obtaining an experienced Health Care Fraud and Insurance Lawyers in Santa Barbara would be your first step in ensuring you are on the correct path to defending yourself.

If you’re facing allegations of health care fraud, then there are several ways to defend yourself against them.

A Santa Barbara health care insurance fraud attorney can help protect your rights by investigating whether or not your actions were truly fraudulent, while also consulting with you on how to handle any charges levied against you.

It’s important to remember that being accused of committing health care insurance fraud is not proof that you did so.

YOU DO HAVE Ways to Defend YOURSELF Against Health Care and Insurance Fraud Charges.

In fact, even if you’ve been charged with committing insurance fraud, it doesn’t mean that you will be convicted—or even charged at all.

That said, one way to defend yourself from such accusations is by proving that your alleged actions weren’t fraudulent in nature. To do so: Document everything. Keep thorough records regarding anything related to billing and claims for reimbursement from Medicare, Medicaid or your respective insurance carrier. This includes your own files and documentation of visits/services provided as well as correspondence between you (the client) and the providers/insurance companies.

Always make sure you communicate any questions or concerns you have with an experienced health care fraud attorney before the legal issues compile.

In most California courtrooms, health care insurance fraud penalties can be severe and often involve time in prison. However, a skilled Santa Barbara health care fraud attorney may be able to negotiate more favorable terms, depending on exactly what happened and what is proven in court.

Penalties for health care insurance fraud include either misdemeanors or felonies and this is all dependent on the total amount of questionable claims that get submitted to the insurance companies.

The crime for health care insurance fraud in Santa Barbara County is typically between five to 10 years in jail or prison.

4 Common Types of Health Care Frauds and How to Recognize Them.

You may have heard the term health care fraud before, but some do not know what it truly entails. There are many different types of health care fraud, and every one of them has its own set of legal implications and penalties, from criminal and civil charges to administrative fines and even asset forfeiture.

Luckily, here are four common types of health care frauds with how to recognize them so you can protect yourself and your loved ones from becoming victims in the future!

Health Care and Insurance Fraud Penalties can be hefty. you need an experienced attorney to help you.

Insurance Fraud

When patients lie about illnesses or injuries to receive more money for medical care than they’re entitled to, it’s considered insurance fraud. Insurance companies that don’t carefully evaluate claims are especially vulnerable—but any company could be, so everyone must take steps to avoid committing insurance fraud. This means being honest with your doctor about your health history and not lying on an insurance claim form. It also means understanding what treatments your plan covers before you undergo them. Ask your insurer directly if you have questions about what’s covered by your plan.

Patient Brokering

Brokering patients is when a provider illegally accepts money or favors in exchange for placing or referring a patient. According to some estimates, it’s an $80 billion industry that costs taxpayers billions. Brokering patients can happen in two ways: first, paying healthcare professionals for referrals; second, accepting kickbacks from third-party service providers who do business with your hospital. Either way, you can be sure that fraudsters are looking for new targets. You can avoid these kinds of fraud by educating yourself on what they look like and how to report them.


A kickback can be defined as an illegal financial arrangement where another pays one party (usually a physician or pharmacy) for some form of referral. This could be in exchange for prescriptions, patient referrals, services not needed, or services not used, etc. Kickbacks are often disguised as consulting agreements with pharmaceutical companies. A physician might accept money from a pharmaceutical company for consulting services to boost sales of their products. For example, a drug company may pay a doctor $100 per month to consult on new drugs. The doctor then prescribes those drugs to his patients even though they aren’t necessary or better than other available treatments.


A doctor or dentist refers their patients for certain services in these situations. This is one of the most common types of health care fraud because it’s so easy for doctors to rationalize. Doctors believe they know what’s best for their patients—and often, it’s true—but that doesn’t mean they can choose who performs certain procedures based on personal relationships. If you see your primary care physician twice a year but then suddenly start seeing him every month, something fishy could be going on. Similarly, if you go to your dentist once every six months but start getting cleanings every two weeks (or even more frequently), there may be an issue. It’s not just dentists and physicians who are guilty of self-referral; chiropractors also engage in these practices all too often.

This is why it’s imperative to hire an attorney as soon as possible.  If you’re facing criminal charges for insurance fraud or another type of crime, you need help from a Santa Barbara health care fraud attorney right away.

Insurance fraud is a very real problem and can come in many forms. For example, if you’re an employee of a medical or health insurance company, you may be tempted to use your access to confidential information for personal gain. This kind of fraud takes many forms, but it’s always illegal—in fact, it can land you in jail.

Health Care Fraud Arrest and Charges: Real-Life Example From The LA Times.

According to a recent article in Los Angeles Times, doctors, nurses and others were charged with taking kickbacks totaling more than $4.2 million in federal reimbursements. This has now recently hit the docket via a health care insurance fraud case.

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