A jury in Orange County recently convicted multiple professionals for insurance fraud. The scheme was estimated to have cost insurance companies more than $150 million. According to prosecutors, healthy patients were recruited for dangerous and medically unnecessary procedures in order to bill the insurance companies. White collar crimes such as insurance fraud are a big target for federal prosecutors these days.
In the present case, the defendants were found guilty on multiple charges including revenue and tax fraud. Each of the defendants faces additional felony counts, which have not yet been tired. The court broke the large case into a series of smaller cases due to the size and complexity of the issues. The remaining charges include grand theft, paying for referrals, tax fraud, conspiracy, and making false claims.
The defendants face a range of potential prison sentences, all less than ten years in duration. In addition to the four who were recently convicted, there are multiple other individuals who were implicated in the scheme and have been charged but not yet tried. Six others pled guilty prior to the grand jury indictment in 2008 and are already serving out their sentences.
In order to convict a person the prosecution must prove each element of the crime beyond a reasonable doubt. Fraud includes 1) a misrepresentation of material fact; 2) that the person knows to be false; 3) made to a person who relies on that misrepresentation; and 4) that results in an injury or loss because of that reliance. A good defense attorney will look at each element in light of the specific circumstances and poke holes wherever possible.
Source: Los Angeles Times, “Four convicted in $154-million medical insurance fraud,” Nov. 26, 2012