Medi-Cal Fraud Laws (Criminal)

Code Section Description Penalty
WELFARE & INSTITUTIONS CODE
§ 14014

(False Declaration as to Eligibility)

  • Person receiving or encouraging another to receive health care
  • For which he or she was not eligible
  • On the basis of false declarations
  • Felony or misdemeanor, depending on amount of fraud under guidelines of Penal Code section 487 (over $400 felony)
WELFARE & INSTITUTIONS CODE
§ 14107

(Fraudulent Claims)
  • Present claim for payment
  • With intent to defraud
  • For goods or services
  • To obtain greater compensation than legally entitled
  • Knowing the information is false
  • Misdemeanor - one year county jail and $1,000 fine.
  • Felony - 2, 3, or 5 years and fine not exceeding three times the amount of fraud or improper reimbursement or value of scheme or artifice.
  • If the execution of a scheme or artifice to defraud is committed under circumstances likely to cause or that do cause two or more persons great bodily injury, or serious bodily injury, a term of four years, in addition and consecutive to the term of imprisonment imposed, shall be imposed for each person who suffers great bodily injury or serious bodily injury.


WELFARE & INSTITUTIONS CODE
§ 14107.2(a)

(Kickbacks, Bribes or Rebates)
  • Solicits or receives any kickback, bribe or rebate to either:
  • Refer or promise to refer person for service or merchandise
  • Purchasing, leasing or ordering service or merchandise


  • Misdemeanor - one year county jail and $10,000 fine.
  • Felony - state prison and $10,000 fine. (Second offense - straight felony)
WELFARE & INSTITUTIONS CODE
§ 14107.2(b)

(Kickbacks, Bribes or Rebates)
  • Offer to pay any kickback, bribe or rebate to either:
  • Refer or promise to refer person for service or merchandise
  • Purchasing, leasing or ordering service or merchandise


  • Misdemeanor - one year county jail and $10,000 fine
  • Felony - state prison and $10,000 fine. (Second offense - straight felony)
PENAL CODE
§ 487

(Grand Theft)
  • A person takes the property of another
  • With specific intent to deprive permanently
  • Took or carried away property


PENAL CODE
§ 550(a)(5)

(Prepare or Make a False Writing)
  • Knowingly prepare, make, or subscribe any writing with intent to present or use it in support of any false or fraudulent claim
  • Misdemeanor - One year county jail and $1,000 fine.
  • Felony - 2, 3, or 5 years state prison plus $50,000 fine or double the amount of fraud, whichever is greater


PENAL CODE
§ 550(a)(6)

(Making a False Claim)
  • Knowingly make or cause to be made any false or fraudulent claim for health care benefit

    When claim or amount at issue is $950 or less:

  • Misdemeanor - One year county jail and $1,000 fine.
  • When claim or amount at issue exceeds $950:

  • Felony - 2, 3, or 5 years state prison plus $50,000 fine or double the amount of fraud, whichever is greater or by county jail one year and fine of $1,000


PENAL CODE
§ 550(a)(7)

(Submitting a False Claim)
  • Knowingly submit a claim for a health care benefit which was not used by or on behalf of the claimant

    When claim or amount at issue is $950 or less:

  • Misdemeanor - One year county jail and $1,000 fine.
  • When claim or amount at issue exceeds $950:

  • Felony - 2, 3, or 5 years state prison plus $50,000 fine or double the amount of fraud, whichever is greater or by county jail one year and fine of $1,000