Healthcare Bro-Stephan.qxp_Bro 1/14/18 10:31 AM Page 1 1 A 7 E C 5 D

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G E . R O T A A O T D R G I S D HEALTHCARE FRAUD N report to: E O I

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T R M S N S P R U A E S P San Diego County District Attorney’s Office Insurance Fraud Division 330 W. Broadway, Suite 700 San Diego, CA 92101 (619) 531-3749 or (800) 315-7672 [email protected] and/or California Department of Insurance Fraud Division 10021 Willow Creek Rd., #100 San Diego, CA 92131 (858) 693-7100 or (800) 927-4357

The District Attorney’s Office will provide speakers to interested groups who wish to learn more about insurance fraud. You may also obtain additional copies of this it costs more than you think 1 0

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San Diego County 0 n w 3 a District Attorney 3 S w Healthcare Fraud Bro-Stephan.qxp_Bro 1/14/18 10:31 AM Page 2

A Message from your District Attorney: How Does the District Attorney Protect Against Prescription Fraud – A Pharmacist inflates bills or falsifies Healthcare Fraud? billing, or a person illegally obtains medical prescriptions Healthcare fraud is a growing industry. The District Attorney’s Office maintains an Insurance Fraud and submits prescriptions for habitual need. Division, which is responsible for filing criminal and civil The General Accounting Office estimates that Dental – Dentist inflates bills, falsifies billing codes or charges after an investigation establishes fraud. District Attorney healthcare fraud, waste and abuse may performs unauthorized services. account for up to 10% of all healthcare Investigators can do independent investigations or work with Cappers and Kickbacks expenditures, which the California Department of Insurance. Our office assigns – Cases where patients are recruited now exceed $2.7 a prosecutor who follows the case from the initial stage and paid to undergo medical treatment, whether those trillion each year. through to completion. procedures were actually performed or not. This means $80 Surgery Center Fraud – Any alleged fraudulent activity Founded in 2005, The Medical and Legal Insurance Fraud billion may be lost in pertaining to outpatient surgery centers. fraud, waste and Task Force works closely with federal, state, and local law abuse annually. enforcement to investigate and prosecute medical and legal The San Diego professionals engaged in insurance fraud. County District What is Healthcare Insurance Fraud? Attorney’s Disability Healthcare Insurance Healthcare Fraud occurs when a medical or legal provider Fraud Unit focuses on prescription, of a service lies to obtain payment or reimbursement they healthcare and disability fraud. Our team of are not entitled to receive. professionals works closely with the California Department of Insurance to Healthcare Insurance Fraud can also occur when an individual, improve public awareness, deter potential during a Workers’ Compensation, automobile, disability, or Auto – Claims made for damage or medical assistance defrauders, and proactively investigate and other medical case, lies to obtain payment or reimbursement which is fraudulent or inflated. This includes individuals prosecute fraud. for injuries or care that did not occur. who stage accidents and injuries in order to collect You can help prevent and stop fraud: insurance payouts. report suspicious activity and if you are billed What Kind of Healthcare Fraud is Prosecuted? Billing Fraud for services not provided, contact your – Occurs when bills are inflated by a medical Workers’ Compensation – Employers and employees insurance company immediately. facility, doctor, chiropractor, laboratory, or when an insurance who lie to get workers’ compensation benefits, to reduce This brochure highlights fraud scams you company is billed for a service or product that was not given. premiums or deny benefits to injured workers. may encounter in workers’ compensation, auto – Providers that intentionally do not report all Long Term Care – Fraudulent invoices submitted regarding insurance and healthcare fraud. of their income and payroll. the type or amount of care provided. I urge you to help our community by – Using someone else’s identity to secure or reporting this fraud to the District Attorney’s What Are the Penalties for Healthcare Fraud pay for health care benefits. Office and the California Department of Convictions? Insurance. Disability – False claims submitted against a temporary or Heathcare Fraud is a felony, punishable by up to five Summer Stephan permanent disability insurance policy or a claimant performing years in prison, restitution, and up to $150,000 in fines. District Attorney, activities exceeding alleged physical limitations. San Diego County