What is a False Representation Under Penal Code section 550?

 Any act or series of acts that are deemed deceptive are then labelled as a “false representation” (or misrepresentation) made to collect money – hence a violation of Penal Code 550 and “insurance fraud”.  This means that conduct that is not listed in an part of the Penal Code, Business & Professions Code and not even barred by medical board regulation – can be anointed by a prosecutor as “fraudulent” and made criminal under PC 550.

Are there Common Law Crimes in California?

Now bear in mind that in California there are no common law crimes.  (See: People v. Whipple 100 CA 261 (1929))  If the crime is not listed in a statute – well, it is not a crime. 

Penal Code Section 550 Creates a Type of Common Law Crime

Penal Code section 550 takes conduct that is not listed in a statute and makes it a crime because it is deemed a “false representation” to an insurance company.  At times this is fair.  If an MD lies about the type of treatment rendered, you are on notice that you are making a “false claim”.  But what about a diagnosis of a medical condition that is not yet established.  For example, some people believe that Alzheimer’s is caused by “type 3” diabetes which effects the metabolism of sugar /insulin in the brain.   It is supported by research and there are protocols for treatment.  If a physician is completely convinced that this is the sole cause of Alzheimer’s and he/she treats all Alzheimer’s patients for type 3 diabetes (even if there are no clinical indications other than cognitive impairment), does this constitute billing fraud IF the diagnosis that accompanies the bills is “Type 3 Diabetes” ?   It might, even though the physician may be acting properly from a medical standpoint.  This is the danger of Penal Code section 550 as they conduct which constitutes fraud is often defined by insurance companies, seminars promoted by prosecutors offices which are funded by insurance donations and by politicians trying to control health care costs.

Penal Code section 550 charges are often unfair and target honest physicians.  Daniel Horowitz has battled the insurance industry, Riverside County prosecutors and other prosecutors winning medical fraud cases.  Call Daniel if you are facing these serious charges.