Insurance Fraud is a Felony

17 According to Section 1871(h) of the California Insurance Code, health insurance fraud is a particular problem for health insurance policyholders. Healthcare fraud causes losses in premium dollars and increases healthcare costs unnecessarily. As mandated by California Insurance Code Section 1872.85(a), funding for the Disability and Healthcare Fraud Program is derived from an annual assessment not to exceed 20 cents annually for each insured under an individual or group insurance policy issued in the State. This funding supports criminal investigations statewide by the Fraud Division and prosecution by district attorneys of suspected fraud involving disability and healthcare fraud. This program area includes suspected fraud involving: claimant disability other than workers’ compensation, dental claims, billing fraud schemes, unlawful solicitation (usually associated with medically unnecessary surgery claims), durable medical equipment, and posing as another to obtain benefits. The National Health Care Anti-Fraud Association reports that in the United States, over $2.5 trillion is spent on healthcare every year. Of this amount, between three to ten percent is lost to fraud. Disability and Healthcare Fraud