2007 California Business and Professions Code Article 12. Insurance Fraud

CA Codes (bpc:810)

810.  (a) It shall constitute unprofessional conduct and grounds for
disciplinary action, including suspension or revocation of a license
or certificate, for a health care professional to do any of the
following in connection with his or her professional activities:
   (1) Knowingly present or cause to be presented any false or
fraudulent claim for the payment of a loss under a contract of
insurance.
   (2) Knowingly prepare, make, or subscribe any writing, with intent
to present or use the same, or to allow it to be presented or used
in support of any false or fraudulent claim.
   (b) It shall constitute cause for revocation or suspension of a
license or certificate for a health care professional to engage in
any conduct prohibited under Section 1871.4 of the Insurance Code or
Section 549 or 550 of the Penal Code.
   (c) (1) It shall constitute cause for automatic suspension of a
license or certificate issued pursuant to Chapter 4 (commencing with
Section 1600), Chapter 5 (commencing with Section 2000), Chapter 6.6
(commencing with Section 2900), Chapter 7 (commencing with Section
3000), or Chapter 9 (commencing with Section 4000), or pursuant to
the Chiropractic Act or the Osteopathic Act, if a licensee or
certificate holder has been convicted of any felony involving fraud
committed by the licensee or certificate holder in conjunction with
providing benefits covered by worker's compensation insurance, or has
been convicted of any felony involving Medi-Cal fraud committed by
the licensee or certificate holder in conjunction with the Medi-Cal
program, including the Denti-Cal element of the Medi-Cal program,
pursuant to Chapter 7 (commencing with Section 14000), or Chapter 8
(commencing with Section 14200), of Part 3 of Division 9 of the
Welfare and Institutions Code.  The board shall convene a
disciplinary hearing to determine whether or not the license or
certificate shall be suspended, revoked, or some other disposition
shall be considered, including, but not limited to, revocation with
the opportunity to petition for reinstatement, suspension, or other
limitations on the license or certificate as the board deems
appropriate.
   (2) It shall constitute cause for automatic suspension and for
revocation of a license or certificate issued pursuant to Chapter 4
(commencing with Section 1600), Chapter 5 (commencing with Section
2000), Chapter 6.6 (commencing with Section 2900), Chapter 7
(commencing with Section 3000), or Chapter 9 (commencing with Section
4000), or pursuant to the Chiropractic Act or the Osteopathic Act,
if a licensee or certificate holder has more than one conviction of
any felony arising out of separate prosecutions involving fraud
committed by the licensee or certificate holder in conjunction with
providing benefits covered by worker's compensation insurance, or in
conjunction with the Medi-Cal program, including the Denti-Cal
element of the Medi-Cal program pursuant to Chapter 7 (commencing
with Section 14000), or Chapter 8 (commencing with Section 14200), of
Part 3 of Division 9 of the Welfare and Institutions Code.  The
board shall convene a disciplinary hearing to revoke the license or
certificate and an order of revocation shall be issued unless the
board finds mitigating circumstances to order some other disposition.

   (3) It is the intent of the Legislature that paragraph (2) apply
to a licensee or certificate holder who has one or more convictions
prior to January 1, 2004, as provided in this subdivision.
   (4) Nothing in this subdivision shall preclude a board from
suspending or revoking a license or certificate pursuant to any other
provision of law.
   (5) "Board," as used in this subdivision, means the Dental Board
of California, the Medical Board of California, the Board of
Psychology, the State Board of Optometry, the California State Board
of Pharmacy, the Osteopathic Medical Board of California, and the
State Board of Chiropractic Examiners.
   (6) "More than one conviction," as used in this subdivision, means
that the licensee or certificate holder has one or more convictions
prior to January 1, 2004, and at least one conviction on or after
that date, or the licensee or certificate holder has two or more
convictions on or after January 1, 2004.  However, a licensee or
certificate holder who has one or more convictions prior to January
1, 2004, but who has no convictions and is currently licensed or
holds a certificate after that date, does not have "more than one
conviction" for the purposes of this subdivision.
   (d) As used in this section, health care professional means any
person licensed or certified pursuant to this division, or licensed
pursuant to the Osteopathic Initiative Act, or the Chiropractic
Initiative Act.