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Self-Assessment Test by Hon. Alex Ricciardulli
1. Medical providers can be prosecuted for knowingly submitting false or fraudulent claims for health-care benefits, and specific intent to defraud is an element of this offense.

True False

2. Depending on the claim amount, submitting false or fraudulent claims for health care can be punished as misdemeanors or felonies, but the dollar amounts claimed or at issue cannot ever be aggregated to meet threshold amounts.

True False

3. Given the vital government need to deter medical fraud, a false statement made to obtain workers' compensation benefits need not be material for the offense to be prosecuted as a felony.

True False

4. Just like submitting false claims for health-care benefits under Penal Code Section 550(a)(6), false claims submitted to the Medi-Cal program are only punishable as felonies if the amount claimed exceeds $950.

True False

5. Under the doctrine of People v. Bailey (1961) 55 Cal.2d 514, multiple, false Medi-Cal claims by a single provider must be consolidated into a single charge and cannot be charged separately.

True False

6. The payment or receipt of unlawful remuneration or kickbacks for the referral of any individual to a person for furnishing services or goods paid for by Medi-Cal is unlawful unless the payment is from an employer to an employee.

True False

7. The "employee exception" in Welfare and Institutions Code Section 14107.2(c) is extremely broad, exonerating both traditional employees and independent contractors from prosecution.

True False

8. Although the federal court has interpreted the Medicare kickback statute to require specific intent, a California appellate court has held that the similarly worded Medi-Cal statute does not require specific intent.

9. Payments for referrals of patients generally, regardless what insurance or government health program the patient is on, are prohibited by Business and Professions Code Section 650, but only professionals licensed under Division 2 of the California Business and Professions Code are covered.

True False

10. Soliciting or referring business for the purpose of insurance fraud is punishable as either straight felonies or "wobblers," depending on whether the defendant has a prior conviction for the same offense.

True False

11. Forging prescriptions or attempting to pass a forged prescription is a felony, but, given the dire need for medical care by competent medical personnel, medical assistants are not barred from prescribing controlled substances.

True False

12. The unlicensed practice of dentistry is a felony regardless of whether it is done under circumstances likely to result in bodily harm.

True False

13. Conviction of an offense "substantially related to the qualifications, functions, or duties of a physician" is deemed unprofessional conduct and is thus grounds for discipline.

True False

14. The Medical Board is required to take action against any license holders charged with unprofessional conduct, and any conviction, whether or not it is for a crime of "moral turpitude," will form the basis for revocation or suspension of a medical license.

True False

15. Physician licenses must be suspended automatically even if the license holder is not incarcerated after conviction of a felony.

True False

16. To protect doctors' right to privacy, misdemeanor convictions are not posted on the California Medical Board's public Web site, even if the misdemeanor resulted in a disciplinary action or accusation that was not subsequently withdrawn or dismissed.

True False

17. As a consequence of criminal conviction, it is mandatory that defendants be excluded from being paid Medicare, Medicaid, or any state health-care program if the conviction was related to a federal or state health-care program, if the conviction was for patient abuse, if the conviction was a felony relating to health-care fraud, or if the conviction was a felony related to a controlled substance.

True False

18. A conviction for the purposes of exclusion includes no-contest pleas that have been accepted even if no sentence is ultimately imposed.

True False

19. Defendants may, but do not have to be, excluded from being paid Medicare, Medicaid, or any state health-care program if they are convicted of a misdemeanor.

True False

20. The Medi-Cal program can temporarily suspend enrolled Medi-Cal providers from the program when it receives information that the provider is under criminal investigation for fraud or abuse.

True False

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