Skip to content
Name: People v. Guzman
Case #: B232299
Court: CA Court of Appeal
District 2 DCA
Division: 6
Opinion Date: 12/12/2011

Where doctor used Medi-Cal billing code to obtain reimbursement for IUD implant, knowing the implant he used was not eligible for reimbursement, there is sufficient evidence to support fraud conviction. Defendant was convicted of one count of fraud under Welfare and Institutions Code section 14107, subdivision (b)(1) for submitting a fraudulent Medi-Cal claim for insertion of an IUD into a patient. In submitting the claim, defendant used the Medi-Cal code for a FDA approved IUD, when he had actually inserted an unapproved, cheaper IUD manufactured in Mexico. The evidence was sufficient to prove an intent to defraud, as the act underlying the conviction occurred after defendant was informed by Medi-Cal investigators that he was not entitled to reimbursement for non-FDA approved IUDs, yet he submitted a claim for a non-approved IUD. Further, defendant provided the investigators with forged invoices for FDA-approved IUDs, which reflects a consciousness of guilt.

Medi-Cal fraud investigators did not commit an illegal search and seizure when they went unannounced to defendant’s office and requested copies of the IUD invoices. Defendant moved to suppress the forged invoices, claiming a Fourth Amendment violation occurred when, without prior notice, the investigators appeared at his office and requested the invoices. Although Welfare and Institutions Code section 14124.2, subdivision (b)(1) provides that unannounced visits to request information are allowable only in exceptional circumstances, the remedy of suppression of evidence is permissible only when compelled by the Fourth Amendment. An otherwise lawful request for documents does not violate the Fourth Amendment merely because the investigators did not comply with statutory requirements. Here, suppression was not required because the investigators gave defendant seven days to produce the documents. The false documents provided were not fruit of the poisonous tree in any event, as this act constituted an independent intervening crime which purged any taint of illegal conduct.