One form occurred when health care providers padded their billings that are, overstating the extent or nature of services to actual patients. In one case prosecuted by the state, an ambulance service that routinely transported patients from a nursing home to a hospital billed the state for a 50-mile round-trip when in fact the distance was 5 miles. The other common form of fraud occurs when providers simply billed for patients they had never seen or for services never provided (Tillman & Pontell 17).
An interesting feature of Tillman and Pontell’s study was that a second sample of “street criminals” was selected for comparative purpose. These criminals were charged with offenses similar to those of the members of the Medicaid fraud sample. In a typical Medicaid fraud case, the defendant was charged with one count of grand theft under the Penal Code (PC) 487, and numerous counts of Welfare and Institutions (WI) Code 14107.5. The sample of “street criminals” was made up of defendants arrested on charges of grand theft and eventually convicted but with no prior arrests within the state of California. California operated under a system of determinate sentencing, which specifies a range of sentences, including sentence lengths for specific offenses. These ranges still allowed for considerable variation in sentences in that the range for many felony offenses includes probation, jail, and prison options. The sentence range for PC 487 and WI 14107 was probation, up to one year in jail, or 16 to 36 months in prison. The California Penal Code (Section 487) defined grand theft as occurring when “the money, labor or real or personal property taken is of a value exceeding four hundred dollars (the value has increased since then).” Table 1 summarizes the characteristics of the members of the Medicaid fraud and the grand theft samples in T&P’s study. Table 2 compares the sentences imposed on the Medicaid fraud sample and