California Criminal Jury Instructions (CALCRIM) (2017)

2000. Insurance Fraud: Fraudulent Claims

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D. INSURANCE FRAUD
2000.Insurance Fraud: Fraudulent Claims (Pen. Code,
§550(a)(1), (4)–(7) & (9))
The defendant is charged [in Count ] with insurance fraud
committed by fraudulent claim [in violation of Penal Code section
550(a)].
To prove that the defendant is guilty of this crime, the People must
prove that the defendant knowingly committed the following crime[s]
[[or] [aided and abetted] [or] [solicited] [or] [conspired with someone
else] to commit (it/them)]:
1.
<Alternative 1A—presented fraudulent claim>
[1. The defendant (presented/ [or] caused to be presented) a false
or fraudulent claim for payment for a loss or injury;]
<Alternative 1B—presented fraudulent claim for vehicle theft or
damage>
[1. The defendant falsely or fraudulently claimed payment for a
loss due to (theft[,]/ [or] destruction[,]/ [or] damage[,]/ [or]
conversion) of (a motor vehicle[,]/ [or] a motor vehicle part[,]/
[or] contents of a motor vehicle);]
<Alternative 1C—writing to be used for fraudulent claim>
[1. The defendant (prepared[,]/ [or] made[,]/ [or] signed or
subscribed) a document with the intent to (present or use it/
[or] allow it to be presented) to support a false or fraudulent
claim;]
<Alternative 1D—made fraudulent claim for health-care benefits>
[1. The defendant (made/ [or] caused to be made) a false or
fraudulent claim for payment of a health-care benefit;]
<Alternative 1E—submitted claim for health-care benefit not used>
[1. The defendant presented a claim for a health-care benefit that
was not used by [or on behalf of] the person named in the
claim;]
<Alternative 1F—presented claim for health-care benefit undercharges>
[1. The defendant claimed payment for undercharges for health-
care benefits for a specific person without presenting for
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reconciliation, at that same time, any known overcharges for
benefits for the same person;]
2. The defendant knew that the claim was false or fraudulent;
AND
3. When the defendant did that act, (he/she) intended to defraud.
Someone intends to defraud if he or she intends to deceive another
person either to cause a loss of (money[,]/ [or] goods[,]/ [or] services[,]/
[or] something [else] of value), or to cause damage to, a legal, financial,
or property right.
[For the purpose of this instruction, a person includes (a governmental
agency/a corporation/a business/an association/the body politic).]
[It is not necessary that anyone actually be defrauded or actually suffer
a financial, legal, or property loss as a result of the defendant’s acts.]
A person claims, makes, or presents a claim for payment by requesting
payment under a contract of insurance for (a/an) ((loss/ [or] injury)/
health-care benefit).
[A claim for payment of a health-care benefit includes a claim submitted
by or on behalf of the provider of a workers’ compensation health
benefit defined in the Labor Code.]
[Conversion of property means interfering with someone else’s property,
without authorization or justification, and depriving the owner of use
and possession of the property.]
New January 2006; Revised February 2012, August 2016
BENCH NOTES
Instructional Duty
The court has a sua sponte duty to give this instruction defining the elements of
the crime.
If the prosecution alleges under a single count that the defendant presented or
caused to be presented multiple claims or made multiple documents in support of a
fraudulent claim, the court has a sua sponte duty to instruct on unanimity. (See
People v. Dieguez (2001) 89 Cal.App.4th 266, 274–275 [107 Cal.Rptr.2d 160].)
However, where the evidence shows a “continuous course of conduct,” a unanimity
instruction is not required. (Id. at p. 275.) If the court concludes that a unanimity
instruction is required, give CALCRIM No. 3500, Unanimity.
If the prosecution proceeds on a theory of aiding and abetting, soliciting, or
conspiracy, give appropriate instructions for those theories.
In element 1, give alternative 1A if the prosecution alleges a violation of Penal
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Code section 550(a)(1). Give alternative 1B if the prosecution alleges a violation of
Penal Code section 550(a)(4). Give alternative 1C if the prosecution alleges a
violation of Penal Code section 550(a)(5). Give alternative 1D if the prosecution
alleges a violation of Penal Code section 550(a)(6). Give alternative 1E if the
prosecution alleges a violation of Penal Code section 550(a)(7). Give alternative 1F
if the prosecution alleges a violation of Penal Code section 550(a)(9).
If a violation of Penal Code section 550(a)(2) or (8) is alleged, give CALCRIM
No. 2001, Insurance Fraud: Multiple Claims. If a violation of Penal Code section
550(a)(3) is alleged, give CALCRIM No. 2002, Insurance Fraud: Vehicle Accident.
If the defendant is charged with a felony violation of Penal Code section 550(a)(6),
(7), or (9), give CALCRIM No. 2003, Insurance Fraud: Health-Care
Claims—Total Value.
Give the bracketed sentence that begins with “For the purpose of this instruction” if
the evidence shows an intent to defraud an entity or association rather than a
natural person. (Pen. Code, § 8.)
Give the bracketed sentence that begins with “It is not necessary” if the evidence
shows that the defendant did not succeed in defrauding anyone.
Related Instructions
See generally CALCRIM No. 400, Aiding and Abetting: General Principles and
CALCRIM No. 401, Aiding and Abetting: Intended Crimes.
CALCRIM No. 415, Conspiracy
CALCRIM No. 441, Solicitation: Elements
CALCRIM No. 2001, Insurance Fraud: Multiple Claims.
CALCRIM No. 2002, Insurance Fraud: Vehicle Accident.
CALCRIM No. 2003, Insurance Fraud: Health-Care Claims—Total Value.
AUTHORITY
• Elements. Pen. Code, § 550(a)(1), (4), (5), (6), (7) & (9).
Intent to Defraud Element of Offense. People v. Scofield (1971) 17 Cal.App.3d
1018, 1025–1026 [95 Cal.Rptr. 405]; People v. Benson (1962) 206 Cal.App.2d
519, 529 [23 Cal.Rptr. 908], overruled on other grounds in People v. Perez
(1965) 62 Cal.2d 769, 776, fn. 2 [44 Cal.Rptr. 326, 401 P.2d 934].
• Intent to Defraud—Defined. People v. Pugh (2002) 104 Cal.App.4th 66, 72
[127 Cal.Rptr.2d 770]; People v. Gaul-Alexander (1995) 32 Cal.App.4th 735,
745 [38 Cal.Rptr.2d 176].
• Intent to Defraud Entity. Pen. Code, § 8.
• Unanimity Instruction. People v. Dieguez (2001) 89 Cal.App.4th 266, 274–275
[107 Cal.Rptr.2d 160].
Secondary Sources
2 Witkin & Epstein, California Criminal Law (4th ed. 2012) Crimes Against
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Property, §§ 222, 224.
6 Millman, Sevilla & Tarlow, California Criminal Defense Practice, Ch. 143,
Crimes Against Property, § 143.01[1][f] (Matthew Bender).
LESSER INCLUDED OFFENSES
Fraudulent claims for health-care benefits, under Penal Code section 550(a)(6) to
(9), are misdemeanors if the total amount of the claims does not exceed $950.
(Pen. Code, § 550(c)(2).) If the defendant is charged with a felony, then the
misdemeanor offense is a lesser included offense. The court must provide the jury
with a verdict form on which the jury will indicate if the total amount of the claims
exceeds $950. If the jury finds that the amount does not exceed $950, then the
offense should be set at a misdemeanor.
RELATED ISSUES
Writing to Be Used for Fraudulent Claim
Penal Code section 550(a)(5) makes it a felony to “[k]nowingly prepare, make, or
subscribe any writing, with the intent to present or use it, or to allow it to be
presented, in support of any false or fraudulent claim.” “Under this section, the
writing required need not be false or fraudulent as long as it is intended to be
presented or used in support of any false or fraudulent claim.” (People v. Zelver
(1955) 135 Cal.App.2d 226, 235 [287 P.2d 183].) In addition, “[i]t need not be
shown that defendant himself executed the false instrument if there is proof that he
procured its execution or aided and abetted another in doing so.” (People v. Singh
(1995) 37 Cal.App.4th 1343, 1376 [44 Cal.Rptr.2d 644].)
Liability of Care Provider
A doctor 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), discussed above. (Ibid.)
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