Articles Tagged with healthcare fraud

According to the California Department of Insurance, insurance fraud occurs when someone knowingly lies to obtain a benefit or advantage to which they are not otherwise entitled. Insurance Fraud also occurs when an insurance company knowingly denies a benefit that is due and to which someone is entitled. 

Other than tax evasion, the National Insurance Crime Bureau (NICB) identifies insurance fraud as the second most costly crime in the country. You may ask yourself, “Why would anyone want to commit insurance fraud?” The answer is simple – for financial gain. Two examples of insurance fraud include:  

  •   report of a San Diego dentist facing 75 felony counts of insurance fraud after allegedly collecting false claims for root canals she never performed.
  • An article about a Yorba Linda man being charged after using stolen identities to receive unemployment insurance benefits.

There are different laws that apply to insurance fraud in California. These laws state:

  • Anyone who willfully injures, destroys, abandons, or disposes of any insured property with intent to defraud the insurer can face jail time up to five years and fines of up to $50,000. 
  • Anyone who solicits, accepts, or refers business with the intention of defrauding an insurance company can face up to three years in jail.
  • Anyone who commits any of the following act can be found guilty of either a misdemeanor or felony crime and face up to five years in prison:
    • Makes or aids in making a false insurance claim;
    • Makes several claims for the same injury or loss;
    • Knowingly cause an auto accident with the intent to collect insurance money;
    • Knowingly file a false or fraudulent medical insurance claim with the purpose of collecting money; and
    • Submit information to support a false or fraudulent insurance claim.

As you can see, there are several categories of insurance fraud — auto, medical, and property. Today, we will focus on auto insurance fraud, which is the most common type of fraud in California. 

Auto Insurance Fraud and California Law

Auto insurance fraud is defined as any criminal fraud that involves auto insurance. If you are intentionally performing the four acts below for personal and financial gain, you are committing auto insurance fraud in California.

 

  • Abandoning or Damaging Your Car: When you leave your car somewhere or use other methods to dispose of your vehicle, you are committing auto insurance fraud.  The same goes if you are burning your car, dumping it in the river, or developing other ways to damage your property. 
  • Providing Insurance Agency with False Information: If you’re giving the insurance company the wrong registration information, you are committing auto insurance fraud. Insurance companies base the price of premiums on location, and if you are scheming to avoid paying higher premiums for your own personal financial gain, you are defrauding your insurance company. In the end, you are cheating yourself and other members of the general public.
  • Filing Multiple Claims for the Same Car Accident: You are committing auto insurance fraud by making more than one claim to the same insurance agency or filing claims with different agencies with hopes of recovering financially.  
  • Filing False Auto Insurance Claims: If you are faking auto accidents or even exaggerating an incident so you can file a false auto claim, you are defrauding an insurance company. As a result, you are committing auto insurance fraud and could face charges.

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An orthopedic surgeon, his lawyer, another doctor, and 12 other defendants (15 in total) have been charged in a California health-care fraud conspiracy in Los Angeles. This past Thursday, Los Angeles county prosecutors handed down indictments for Dr. Munir Uwaydah and the associates who helped cover his illicit activity. The conspiracy ring is alleged to have prescribed unnecessary expensive medications, billed two-minute doctor’s appointments as hour-long examinations, and doctored MRI results and medical records to justify unnecessary operations.  It is also alleged that Dr. Uwaydah allowed his physician’s assistant, Peter Nelson, to perform surgeries at an Orange County hospital in 2005. Dr. Uwaydah’s medical license was revoked two years ago after several earlier allegations.

The conspiracy ring is estimated to have cheated insurance companies out of $150 million. It is described as one of the largest health-care schemes in state history. Uwaydah and Nelson are charged with 21 counts of aggravated mayhem — each for a different patient. The District Attorney stated that this is a vast underestimation of the hundreds of procedures that Nelson performed. Nelson is being held on a $21 million bail. The office manager, Kelly Soo Park, 49, is also being held on $18.5 million bail in the fraud case for her involvement in hiding Uwaydah’s money from investigators.  

Health Care Fraud in California