A 52-year-old Mission Viejo woman has been arrested and charged with defrauding the Orange County Social Services Agency of nearly $150,000. According to a news report by The Orange County Breeze, she faces one felony count each for medical insurance fraud and misappropriation of public funds, with sentencing enhancements for aggravated white collar crime over $100,000, property loss over $65,000, and $100,000 in other losses. Officials believe that she fraudulently claimed to be the full-time caretaker for her parents, inflated the number of hours spent as caretaker and claimed more hours than permissible under the law. She faces up to eight years in state prison and is being held on $150,000 bail.
The defendant’s 72-year-old mother has also been charged with one felony count of medical insurance fraud and faces several enhancements as well. A warrant has been issued for her arrest and she faces up to six years in state prison. A 55-year-old Lake Forest woman is suspected of the same counts as the 52-year-old Mission Viejo woman, but she has not been arrested and is believed to be in Iran. Officials say the mother and co-defendant knowingly approved fraudulent hour documentation.
Under California Law, fraud occurs when someone purposefully lies to gain a benefit or advantage to which he or she would not otherwise be entitled. Examples of medical insurance fraud include but are not limited to:
- Suspicious slip-and-fall claims
- Inflated billing by a medical professional
- Disability claim involving an exaggeration of the injuries suffered
- Embezzlement of funds
- Billing for medical services not rendered or needed
- Using benefits to cover prescriptions not prescribed by a doctor
- Allowing someone else to use identity to obtain heath care services
Insurance fraud is a complicated criminal offense that can result in years of incarceration. Talking with the authorities without an Orange County criminal defense attorney present or accepting a plea deal without fighting the charges can have devastating consequences. Anyone facing fraud or other serious charges should act quickly in hiring an experienced criminal defense attorney.