California Healthcare Fraud Whistleblower Lawyer
California has some of the best healthcare infrastructures in the nation. However, unfortunately, no one is immune to healthcare fraud, and the Golden State is no exception. Witnessing medical fraud within your own company can leave you unsure about how to proceed and what to do with the information you have.
If you find yourself in this type of situation, consult with a California healthcare fraud whistleblower lawyer about your potential next steps. Below, we will give you an overview of common types of medical fraud in California, what a whistleblower can do to stop it, and how you might be able to collect a reward for blowing the whistle on fraud. Let our qui tam attorneys help you expose healthcare fraud in California.
Did You Witness Healthcare Fraud in CA?
Healthcare fraud wastes taxpayer money and puts patients at risk of harm. That is why blowing the whistle on medical fraud is so important. The lawyers of Tycko & Zavareei LLP can help you do the right thing and report instances of healthcare fraud in California through the proper channels.
Common Examples and Types of Healthcare Fraud in California
Witnessing wrongdoing within your company can be confusing, especially if you are not familiar with the various types of healthcare fraud. Medical fraud happens when a healthcare provider is dishonest when reporting to the government or insurance companies, in order to gain a profit.
Here are just a few examples of healthcare fraud that are common in California:
- Submitting false insurance claims
- Recommending unnecessary procedures for profit
- Billing for services never rendered
- Billing for more expensive services than the ones that were rendered
- Duplicate billing
- Unbundling services to make them more expensive
- Kickback schemes
This list is not exhaustive. Any type of dishonest healthcare-related action that leads to unfair profits and which harms the government could be considered medical fraud.
Who Are Healthcare Fraud Whistleblowers?
If you witnessed your organization potentially committing healthcare fraud, you might want to report such wrongdoing. The whistleblower journey is complex, but it may be worth navigating from both an ethical perspective and for the guaranteed reward in the event of a successful case.
Once retained, a qui tam attorney would help you become a healthcare fraud whistleblower by reporting the alleged medical fraud to the appropriate agencies. Then, if the government decides to take up your case, an investigation would begin.
The Federal False Claims Act
Blowing the whistle is made possible in large part due to the federal False Claims Act. Under this statute, any individual who knowingly attempts to defraud the federal government may be held liable in civil court. Whistleblower lawsuits, or qui tam claims, involving federal funds are filed by whistleblowers on behalf of the federal government. This law also requires whistleblowers to have legal representation.
California State Whistleblower Laws
While the federal False Claims Act applies to healthcare fraud committed against the federal government, California has its very own whistleblower law for fraud against the state government. Specifically, the California False Claims Act allows the Attorney General to pursue a lawsuit against anyone who fraudulently attempts to obtain money or property from the State, and allows whistleblowers to file qui tam lawsuits on behalf of the State. Rather than representing the federal government, the whistleblower and their attorney represent the State of California.
The California Insurance Frauds Prevention Act
The California Insurance Frauds Prevention Act (IFPA) is a groundbreaking law designed to combat insurance fraud and safeguard Californians from its widespread impacts. First passed in 1993 to address workers’ compensation fraud, the law has since expanded to cover an array of fraudulent activities, from healthcare overbilling to auto insurance scams. What sets the IFPA apart is its ability to target private insurance fraud—a unique feature shared by only one other state. Under the act, whistleblowers, or “qui tam relators,” can report fraudulent claims that harm the public without requiring direct damages to the government, closing crucial loopholes. Whistleblowers under the IFPA are eligible for substantial rewards, with compensation potentially reaching up to 50% of recovered funds in some cases. They are also protected from employer retaliation through clear legal provisions. The IFPA is a vital tool for reducing fraud, lowering insurance costs, and encouraging integrity within the insurance industry, making it a crucial example of fraud-fighting legislation.
Whistleblowers’ Rights, Responsibilities, and Rewards
If you decide to report the healthcare fraud you witnessed, you will have certain rights under both the federal and California False Claims statutes. For example, both laws will protect you from retaliation by your employer. Employer retaliation includes termination, demotion, harassment, and discrimination, in response to a protected disclosure.
The federal False Claims Act gives you the right to confidentiality during the initial investigation of your claim, and entitles you to a reward of 15 to 30 percent of the settlement reached in a successful verdict. The California False Claims Act also promises a whistleblower reward in successful qui tam lawsuits but does not specify a percentage range. For a better understanding of what a whistleblower reward might look like, check out these whistleblower success stories.
Notable Healthcare Fraud Lawsuits and Settlements in California
In August 2022, the Gold Coast Health Plan entered into a $70.7 million settlement after reportedly misusing government funds. Rather than returning funds under the “medical loss ratio” guidelines in the Affordable Care Act, Gold Coast was accused of distributing the money to healthcare providers for “additional services” that were never actually rendered to the patients.
In October 2022, Sutter Health entered into a $13 million settlement after reportedly violating the False Claims Act by billing the government for toxicology screening tests performed by outside labs.
Should You Hire a Qui Tam Lawyer?
Are you considering blowing the whistle on healthcare fraud in California? If so, selecting the right whistleblower law firm is an important step in the process. Hiring legal experts, like the ones at Tycko & Zavareei LLP, who have extensive experience with qui tam lawsuits, will give you an advantage throughout the journey.
Work with a California Healthcare Fraud Whistleblower Attorney
When you witness healthcare fraud taking place in a company or organization, you may feel unsure about how to handle the situation and what to do with the information. In most cases, you are coming from a position of lesser power, so it makes sense to be concerned about the possible repercussions of blowing the whistle on your company.
The good news is that a qualified California healthcare fraud whistleblower lawyer can help you level the playing field. An attorney at our firm can inform you in detail about your rights as a whistleblower in California and the benefits of seeking out a qui tam claim.
Here at Tycko & Zavareei LLP, our experienced California healthcare fraud whistleblower attorneys can help you make an informed decision about whether filing a qui tam claim is in your best interests. Schedule a confidential case evaluation now to learn more about how our team can help you.