What is California Welfare & Institutions Code § 14014: Fraudulent Declarations in Medi-Cal Eligibility
In California, Medi-Cal (the state's Medicaid program) provides essential health coverage to millions of low-income individuals, families, children, seniors, and people with disabilities. The federal government matches a portion of the state's spending through a formula called FMAP. In California, the standard FMAP is 50%, meaning the federal government pays $1 for every $1 the state spends, but some programs and populations receive an enhanced rate.
The program is expensive and the state and federal government have dedicated investigative units designed to find fraud in Medi-Cal applications for benefits.
One of the primary statutes governing beneficiary-side Medi-Cal fraud is Welfare & Institutions Code § 14014. This section targets false statements made to obtain health care services.
What Does § 14014 Actually Say?
The core of the law (subdivision (a)) states:
Any person receiving health care for which he or she was not eligible on the basis of false declarations as to his or her eligibility or any person making false declarations as to eligibility on behalf of any other person receiving health care for which that other person was not eligible shall be liable for repayment and shall be guilty of a misdemeanor or felony depending on the amount paid on his or her behalf for which he or she was not eligible.
The law also covers people actual receive the benefits and those who counsel or encourage others to lie (subdivision (b)), making them civilly liable for the cost of improperly provided services.
Key Elements the Prosecution Must Prove
To convict someone under § 14014, prosecutors typically need to show:
1. A false declaration was made (intentionally or knowingly).
2. The false statement resulted in the person receiving health care they were not eligible for.
3. The state actually paid for those services on their behalf.
Penalties Under § 14014
The criminal penalty is tied directly to California's grand theft statute (Penal Code § 487), which classifies theft by the value of what was taken. In essence then, this section is a form of theft couched in language specific to obtaining medical benefits.
