Seeking Reimbursement for Insertion of Unapproved IUD Constitutes Fraud

An obstetrician-gynecologist was convicted of Medi–Cal fraud, the crime of presenting for payment any false or fraudulent claim for services or merchandise. Medi-Cal authorizes the use of only one FDA-approved IUD, the ParaGard IUD, and reimbursement may be sought only for that type. From 2004 through February 2006, the appellant's office billed Medi–Cal for the insertion of 176 IUDs under procedure code X1522. For these IUDs, Medi–Cal paid appellant $45,919.72. During this period, appellant did not use the ParaGard IUD. Instead, he used a cheaper Copper T type IUD manufactured in Mexico by Dentilab.


The defendant intended to defraud, and committed Medi-Cal fraud, when the defendant submitted the false claims for reimbursement for an IUD approved by the FDA and used the code knowing it designated only an FDA-approved IUD but the defendant actually inserted in the patient the non-FDA approved IUD. Even though the defendant received a warning from Medi–Cal fraud investigators that the non- FDA approved IUD was not reimbursable, the defendant's office submitted a claim for a non-FDA approved IUD five days later, and when asked to provide invoices for FDA-approved IUDs the defendant provided forged invoices.


In addition, the Fourth Amendment did not require suppression of the forged invoices the defendant provided to Medi–Cal fraud investigators in response to their request, even if the investigators violated a state notice statute in arriving at the defendant's office unannounced, when the investigators gave the defendant seven days to produce the invoices rather than demanding the immediate production of the records, and the forgery was a new and distinct crime from the underlying fraud. See: People v. Guzman, 201 Cal.App.4th 1090, 134 Cal.Rptr.3d 66 (Cal.App. 2 Dist. Dec 12, 2011).