11210 Definition of Fraud

A fraudulent error occurs when the client intentionally:

Makes false or misleading statement, misrepresentation, concealment, or withholding of facts for the purpose of improperly establishing or maintaining eligibility [see 11221 (3) ]; or

Misuses medical benefits, including selling, sharing or trading the medical I.D. number for money or other renumeration, signing for services that were not provided to the recipient, or other misuse as determined by the agency.

An individual shall be considered to have committed fraud when the individual has been legally determined to have committed fraud through a court of appropriate jurisdiction. There is no other method of establishing a fraud claim.

A finding of fraud under these provisions may result in criminal penalty, including fines and imprisonment, but may only result in a period of ineligibility if so ordered by the court. See 11126.2 . Fraud error status is not established if the court’s resolution to the willful client error is to place the individual on diversion.