Whistleblowing and Healthcare Fraud in CA
| Read Time: 4 minutes | Whistleblower

Healthcare fraud is a widespread problem that drives up the cost of care for anyone who needs to use our already expensive American healthcare system. Unfortunately, fraudulent claims are estimated to comprise as much as 10% of all U.S. healthcare expenses annually. That means almost $230 billion may be going directly into the pockets of fraudsters. 

While there are various ways that healthcare fraud is perpetrated, the most common fraud is false claims against the government for reimbursement under Medicare and Medicaid. The federal government’s False Claims Act (FCA) rewards healthcare fraud whistleblowers who help provide information or otherwise assist in bringing wrongdoers to justice. California has a similar statute covering whistleblowing and healthcare fraud

Blowing the whistle on healthcare fraud can be risky since whistleblowers are often subjected to serious retaliation and harassment by their peers or employer. However, under the False Claims Act, the government has recovered over $38 billion of taxpayer money that was lost to fraud. Whistleblowers may be entitled to awards of 15 to 30% of the government’s recovery.

At King & Siegel, LLP, we represent whistleblowers and employees in qui tam and retaliation cases. This blog post will tell you more about what healthcare fraud is, how to identify it, and how to protect yourself if you have blown the whistle on your employer. If you have any questions, don’t hesitate to contact King & Siegel, LLP today.

What Is Healthcare Fraud?

Healthcare fraud is a type of fraud perpetrated against the government by over-billing state or federal insurance programs like Medicare or Medicaid (called Medi-Cal in California). This fraud can be committed by healthcare providers, facilities, and even patients themselves. Acts of healthcare fraud include:

  • Misrepresenting Medicare and Medicaid claims,
  • Deliberately miscoding procedures,
  • Performing medically unnecessary procedures for the sole purpose of increasing billings,
  • Identity theft or identity swapping,
  • Fraudulent representations by a hospital or other healthcare facility,
  • Accepting kickbacks for patient referrals to a healthcare facility, and
  • Misleading product and device claims by a drug company or medical device manufacturer.

This is not an exhaustive list of potentially fraudulent acts. Healthcare fraud can be frustratingly difficult to identify and stop because federal law requires that insurance companies pay provider claims within 30 days. Anti-fraud teams are constantly in a race against time. If you are a healthcare provider or you work at a medical facility and believe you are a witness to healthcare fraud, do not hesitate to contact a whistleblower attorney. You can protect yourself and others by learning more about and potentially preventing whistleblowing and healthcare fraud in California.

What Does It Mean to Be a Whistleblower?

A whistleblower under the False Claims Act is someone with inside information about potential fraud. In the context of healthcare, whistleblowers can be employees of healthcare providers, employees of vendors or affiliated companies, or patients, among other things.

As a patient, you can blow the whistle on healthcare fraud if you see charges on your medical bills for procedures that were never performed. Check the  “explanation of benefits” (EOB) statements you receive from your insurance company to ensure the services listed have actually been provided by your doctor or healthcare facility. Raise questions about anything that does not make sense. 

If you are a healthcare provider or work in a medical facility or office and observe or are asked to perform fraudulent acts, meet with a whistleblower attorney right away to discuss your options. Your lawyer can help you decide whether to take the information to a law enforcement agency like the FBI. An experienced whistleblower attorney will also talk to you about any risks to your employment and what you need in terms of whistleblower protection. The King & Siegel team has years of experience helping patients and medical professionals stand up to whistleblower retaliation and obtain compensation not only for blowing the whistle on healthcare fraud but for fighting back against retaliation.

Do I Have a Right to Be Protected from Whistleblower Retaliation?

In California, employees who lose their jobs for good faith complaints about illegal conduct or who are terminated for reporting illegal activity to authorities are protected by multiple laws. California Labor Code § 1102.5 provides that your employer cannot retaliate against you for reporting conduct you reasonably believe to be unlawful either through your company reporting mechanisms (like human resources) or to appropriate government agencies. The law also prohibits employer retaliation if you refuse to participate in your employer’s illegal conduct. 

California Labor Code § 6310 provides that your employer cannot retaliate against you for complaining about workplace safety issues. Section 6310 also makes retaliation a crime punishable as a misdemeanor.

California Labor Code § 6310 provides that your employer cannot retaliate against you for complaining about workplace safety issues. Section 6310 also makes retaliation a crime punishable as a misdemeanor. California Labor Code § 6311 prohibits retaliation against employees who refuse to participate in violating any occupational safety or health standard where participation would create a real and apparent hazard to an employee or co-workers. This can come up in a healthcare setting where chronic understaffing leads to patient and workplace safety issues.

California Health and Safety Code § 1278.5 applies specifically to health facilities. This provision prohibits health facilities from retaliating against employees who make complaints regarding quality of care, services, or conditions at a healthcare facility. 

If you are terminated because you reported illegal conduct internally or to law enforcement, or because you simply refused to participate personally in the illegal conduct, contact King & Siegel as soon as possible to discuss your options.

The King & Siegel Difference

At King & Siegel, our Los Angeles whistleblower lawyers have worked on whistleblower and False Claims Act cases against some of the biggest government contractors and private companies. We are passionate about representing whistleblowers. It is an honor to represent workers brave enough to resist a culture of misconduct. And unlike many other qui tam attorneys, we are experienced in both qui tam litigation and employment litigation.Contact us by phone, text, or online for a case evaluation and to discuss your rights. You pay only if we win.

Author Photo

Elliot Siegel graduated with honors (cum laude) from NYU School of Law and practiced at some of the country’s biggest litigation firms where he learned to litigate strategically, aggressive, and efficiently by some of the best trial lawyers in the Country. It was here that Mr. Siegel saw how important access to competent and good counsel was in navigating the legal system, and how rarely employees and other members of the public could find that type of representation. This realization led him to dedicate his career to representing employees and consumers who lacked the resources to protect themselves from being preyed on by their employers or unscrupulous businesses by co-founding King & Siegel in early 2018.