California Physician Penal Code 550 Defense Attorney | Medical Billing Fraud Lawyer
If you are a California physician under investigation or charged with Penal Code 550 (PC 550) for insurance fraud or medical billing issues, you need immediate, experienced legal defense. What often starts as a billing dispute, audit, or coding disagreement can quickly escalate into serious criminal charges.
The Law Office of Daniel Horowitz provides aggressive and strategic defense for doctors facing PC 550 fraud allegations throughout California.
Call (925) 291-5388 today for a confidential consultation. Early intervention is critical.
What is Penal Code 550 and How Does It Apply to Physicians?
Penal Code Section 550 is California’s primary insurance fraud statute. It criminalizes the knowing submission of false or fraudulent claims to insurance companies, including health insurers, Medi-Cal, Medicare, and workers’ compensation carriers.
For physicians, PC 550 charges commonly arise from:
- Upcoding or unbundling of services
- Billing for services not rendered
- Alleged false documentation in support of claims
- Patterns of billing deemed fraudulent by insurance companies or prosecutors
Insurance carriers frequently refer billing disputes to prosecutors, turning what used to be civil or administrative matters into criminal cases.
Serious Consequences for Physicians
A PC 550 conviction or even investigation can be career-ending for a doctor:
- Criminal Penalties: Felony charges carry 2, 3, or 5 years in state prison, fines up to $50,000+, and restitution.
- Medical License Risk: Automatic trigger for a Medical Board of California investigation and possible Section 805 report.
- NPDB Reporting: Adverse actions are reportable to the National Practitioner Data Bank.
- Hospital Privileges: Loss or restriction of medical staff privileges.
- Civil Penalties: Additional Insurance Code § 1871.7 penalties up to $150,000+.
Why Doctors Get Targeted
Many physicians are shocked to learn that routine billing practices — especially aggressive coding or high-volume procedures — can lead to PC 550 charges. Prosecutors often work closely with insurance companies looking to recover money and make examples of providers.
Proven Results Defending Healthcare Providers
Daniel Horowitz has a strong track record successfully defending physicians and chiropractors against PC 550 and related fraud charges, including:
- Dismissal of PC 550 charges in Orange County (Barsoum & Reyes case)
- Successful defense of Dr. Wilmer Origel, D.C. in the landmark Stockton medical fraud trial
- Jury acquittal for Dr. Sohila Bodner in a PC 550 case in Hayward
- Multiple dismissals and favorable resolutions in healthcare billing fraud investigations
These results demonstrate our ability to fight aggressively and achieve dismissals even in complex medical fraud cases.
Strong Defenses in Physician PC 550 Cases
- Lack of specific intent to defraud (coding disagreements vs. fraud)
- Good faith reliance on billing companies or staff
- Insufficient evidence of knowing falsity
- Challenging the reliability of insurance company audits and expert testimony
- Constitutional and procedural defenses
We focus on preventing charges when possible and mounting a powerful defense when charges have already been filed.
What to Do If You Are Under Investigation or Charged
- Do not speak with investigators, insurance auditors, or law enforcement without an attorney.
- Preserve all records exactly as they are.
- Contact an experienced PC 550 defense lawyer immediately — timelines are critical.
- Avoid making any repayments that could be interpreted as an admission of guilt.
Protect Your License, Freedom, and Career
At the Horowitz Physician Defense Law Group, we understand both the criminal and medical regulatory sides of these cases. We combine board-certified criminal defense expertise with deep knowledge of healthcare billing regulations to protect doctors facing PC 550 allegations.
“They have attorneys — so should you.” — Daniel Horowitz
Call (925) 291-5388 right now for a confidential consultation. We defend physicians across California, including Contra Costa County, the Bay Area, Los Angeles, San Diego, Sacramento, and Central Valley.
Can You Be Prosecuted for a Penal Code section 550 Violation if Someone Else Files the Form?
Physicians or Chiropractors or other care provider who prepares false documents for a fraudulent insurance claim may be prosecuted under Penal Code section 550(a)(1) for “causing the presentation of a fraudulent claim,” even though another person actually presents the claim. (People v. Singh (1995) 37 Cal.App.4th 1343, 1369–1370 [44 Cal.Rptr.2d 644].) Alternatively, the care provider may be prosecuted under Penal Code section 550(a)(5). So this is a crime focused on the claim presented and not the mechanics as to who actually signed the claim form.
Is the Penal Code Section 550 Charge a Felony or Misdemeanor?
The amount of the claim is crucial. Fraudulent claims for health-care benefits under Penal Code section 550(a)(6) to (9) are considered misdemeanors if the total amount does not exceed $950 (Pen. Code, § 550©(2)). If the defendant is charged with a felony, the misdemeanor offense is included as a lesser offense. The court must provide the jury with a verdict form to indicate whether the total amount of the claims exceeds $950. If the jury finds that the amount does not exceed $950, the offense should be classified as a misdemeanor. This determination is made by the jury. If the jury finds the defendant guilty of insurance fraud related to health-care claims, they must also decide whether the prosecution has proven that the total value of the false claims exceeded $950 within a period of 12 consecutive months.
Penal Code Section 550 Defenses
See: Defenses to Fraud in PC 550 Cases
The Williamson Defense to Penal Code section 550 Insurance Fraud Cases
Defense of insurance fraud cases is not a do it yourself project. You need the best lawyer who specializes in criminal defense and criminal fraud defense. Lawyers in Lafayette is a group of affiliated top criminal defense lawyers including former prosecutors and certified criminal defense specialists (State Bar of California, Board of Legal Specialization). Call us if you are facing criminal fraud charges.
Located in Contra Costa County, our group of affiliated independent attorneys (Lawyers in Lafayette) defend Penal Code section 550 cases throughout California. Recent cases are in Tehama County and Riverside (Orange County).
Defending criminal cases from Walnut Creek to Los Angeles and nationwide. Daniel Horowitz is a criminal defense specialist, one of less than 10 in all of Contra Costa County. His main office is in Lafayette, California. On criminal cases requiring a high level of expertise and experience he is contacted by clients and lawyers statewide.
Client Testimonials
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My experience with Dan was great. I appreciate the knowledge Dan has and the professionalism they exhibit. I would highly recommend the Law Office Of Daniel Horowitz. My family and I are truly grateful we worked with him.Brandon D.
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There are lawyers and then there are real lawyers. Dan Horowitz is a real lawyer in every since of the word. Dan is a Certified Specialist in Criminal Law. You will not find very many attorneys having such recognition especially one that hits on all cylinders as Dan. In addition to his knowledge of the law and his experience, which I found to be unmatched, i appreciated the fact that he at all times is genuine, which for me says it all. Thank you Dan.Cory N.
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Tough, humble, has integrity - simply THE best. With Dan it is not so much about the money but about doing what is right. A very rare breed. He has honesty and integrity and the jurys see it. If he doesn't believe in the case or the client he won't waste your time or his. But you better listen to him!...Believe an trust in him. I did and I am totally indebted to him. He is "The best of the best." Thank you Dan for all you have done and continue to do. Carole~ Arbuckle v. Board of Chiropractic ExaminersCarole A.
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He told me that he hadn't lost a trial in a long time and he didn't want mine to break the streak. I didn't either! We went to trial and he was in control of the courtroom. He was totally prepared. But I was still worried because the prosecutor was very good as well. Daniel was confident but honest. The jury really liked him. As you can tell, he won my case because I am here, writing this review. Thank you.Michael M.