Do You Have Information about a California Healthcare Provider Falsely Billing Medicare or Medicaid?
Blowing the whistle on Medicaid fraud keeps the cost of health care down for everyone, ensures patient safety and encourages corporate integrity. According to a recent PricewaterhouseCoopers survey, nearly 43% of all government and corporate fraud in our nation is discovered by whistleblowers coming forward – twice the amount detected through audits and other regulatory avenues.
The frequency of illegal conduct in California’s health care industry is shocking. Most health care professionals refuse to participate in Medicaid fraud and understand that this behavior is dishonest, dangerous, and illegal.
Yet the fear of employer retaliation keeps many people from acting to put a stop to fraudulent conduct. Inaction in response to fear and intimidation is tragic. It not only indirectly supports the employer’s illegal conduct, but also puts innocent taxpayers at risk for ill-managed patient care and unaffordable health care costs. Also, there are strong job protections in California’s False Claims Act with powerful penalties against employers who harass or fire an employee for reporting fraud.
Intuition speaks volumes. If you feel that your employer is currently or has been submitting false or fraudulent claims to Medicaid, they most likely are.
Whether the conduct you suspect is illegal or merely on the verge of violating the law, reporting your suspicions to the Medicaid Fraud Hotline is the smartest move you can make. Your actions are protected by law and a free claim evaluation is completely confidential.
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Reporting California Medicaid Fraud
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What California Statutes Are Involved In Reporting Medicaid Fraud?
A number of California laws lay out the right and protections that whistleblowers have when they chose to report Medicaid fraud, including the California False Claims Act, California’s Whistleblower Statute, the California Whistleblower Protection Act and California’s Health and Safety Code.
California False Claims Act (Cal. Gov’t Code §§ 12650-12656)
In 1987, California became the first state to adopt its own False Claims Act. The California False Claims Act (CFCA), like the federal False Claims Act, allows private individuals – “qui tam plaintiffs” to bring an action on behalf of the government against an entity or person who “knowingly” has defrauded the government out of “money, property or services” through submitting a false claim, false record or false statement to the government for payment.
Treble damages, civil penalties of up to $10,000 for each false claim, and litigation costs are imposed on those who violate the CFCA, and the whistleblower who brought the initial action is entitled to a share of up to 50% of the money recovered by the government in trial or settlement.
Specifically, a whistleblower may file suit against anyone who:
- Knowingly presents or causes to be presented to an officer or employee of the state or any political subdivision thereof, a false claim for payment or approval.
- Knowingly makes, uses, or causes to be made or used a false record or statement to get a false claim paid or approved by the state or by any political subdivision.
- Benefits from an inadvertent submission of a false claim, discovers the submission, and fails to disclose the submission within a reasonable time.
While the CFCA was modeled after the Federal False Claims Act, it contains various unique provisions. The CFCA provides for an award to the relator of up to 50% of the proceeds, as opposed to the federal award of up to 30%. The CFCA also allows the Attorney General to intervene up to the time of judgement, even if they had previously declined to intervene.
Unlike the Federal False Claims Act, a “false claim” under the CFCA does not actually have to be false. The requirement is instead that the claim be “underpinned by fraud.” The CFCA imposes liability for any person who knowingly benefits from the submission of a false claim, whether or not they themselves submitted the claim. Government contractors that do business with the State of California are also liable under the CFCA if they knowingly submit a claim while in breach of a material contract.
California’s Whistleblower Statute (Cal. Labor Code §§ 1102.5-1105)
California’s Whistleblower Statute provides protection for both public and private employees who report information, conduct or other activities that they reasonably believe is in violation of a local, state, or federal law, rule or regulation.
The protections extend to employees who report to either internal or external entities – including compliance officers. The protections extend liability beyond mere employers to any person working with an employer who retaliates against an employee because they blew the whistle. The statute also makes it illegal for employers to punish employees for refusing participation in illegal activities and extends protections to “anticipatory retaliation,” prohibiting employers from retaliating against an employee they fear may report illegal activity in the future.
The California Whistleblower Statute enables those eligible for protection to file a claim for damages sustained from the retaliation, including back pay for lost wages, job reinstatement and other special damages that may apply. An employer’s violation of the statute faces up to one year in county jail and/or a $1000 - $5000 fine.
California’s Whistleblower Protection Act (Cal. Gov’t Code § 8547.1, et seq.)
California’s Whistleblower Protection Act was enacted to ensure that state employees feel free to report waste, fraud, abuse of authority, violation of law, or threat to public health without fear of retribution. This Act prevents all forms of retaliation by employers in response to an employer blowing the whistle, including coercion, demand to participate in illegal activity, disciplinary action, promotion/raise denial, required transfers, reassignment to lower position or lesser pay, intimidation, threats or termination.
California Health and Safety Code § 1278, et seq.
California’s Health and Safety Code protects medical staff, doctors and nurses from retaliation due to reporting activities that affect patient care and safety.
If you feel you have knowledge of Medicaid Fraud, call the Medicaid Fraud Hotline now. Statutes of limitations make early reporting imperative, as do requirements for “original and non-public information” that make the first person to report knowledge of fraud the only one eligible for a whistleblower cash reward.
What Whistleblower Protections Are Provided For Reporting California Medicaid Fraud?
Whistleblower protection laws are in place to encourage employees to come forward with knowledge of employer activity that is in violation of public policy and/or may constitute a danger to the public. An employee need not prove an employer has violated the law before reporting Medicaid fraud. The employee only needs a reasonable suspicion of illegal activity.
The CFCA along with the California Whistleblower Statute and California Whistleblower Protection Act contain a number of provisions that give both public and private employees substantial protections against employees who attempt to retaliate against them for reporting Medicaid fraud either internally or externally.
Retaliation is any action taken by an employer to punish an employee for reporting a suspected legal violation, including:
- Loss of job
- Threat of job loss
- Loss of seniority
- Suspension without pay
- Abnormal change in shifts or responsibilities
In order to file an anti-retaliation claim, the employee must be able to demonstrate that:
- The employer had knowledge of the employee’s intent to report a suspected illegal activity
- The retaliation was motivated in part by the employee’s intent to report a suspected illegal activity
- They were subjected to an adverse material change in the terms and conditions of their employment. Though write-ups and remarks may be useful as evidence, they do not normally apply as retaliation as they are not a “material change.”
- They would not have been subject to the adverse action in the absence of their intent to report the suspected illegal activity.
The ability to demonstrate the employer’s knowledge of the intent to report fraud, a change in treatment of the employee once the knowledge was gained, the timing of the retaliation in relation to the disclosure, previous communication of a satisfactory work record and/or similar retaliation actions regarding other employees in the past can all play a strong role in an anti-retaliation case.
Whistleblower protections provided by the CFCA, are even stronger than those of the federal False Claims Act, prohibiting employers from implementing policies that in any way prevent employees from reporting fraud and providing punitive damages for retaliatory behaviors.
If you feel that your employer has taken retaliatory action against you for reporting (or intending to report) Medicaid fraud, call the Medicaid Fraud Hotline for a free, confidential consultation to discuss your options and potential remedies under California and Federal law.
Are There Cash Rewards for Reporting California Medicaid Fraud?
Under the CFCA and the federal False Claims Act, qui tam plaintiffs are awarded a percentage of the government’s recovery upon judgement or settlement approval. If the Attorney General chooses to intervene in the case, the qui tam plaintiff may collect between 15-33% of the recovery amount. If, on the other hand, the Attorney General decides not to intervene and the whistleblower continues with a private attorney, the award increases to between 25-50% of the recovery amount.
In addition to this significant cash award, the whistleblower is also entitled to attorney’s fees, costs and expenses.
Act now to secure your position as whistleblower and begin building your case. Contact the Medicaid Fraud Hotline for a free, fully confidential case evaluation. We will discuss your options and help ensure you are taking the appropriate steps to legally maximize your claim.
Are There Time Limits To Reporting California Medicaid Fraud?
Once you have knowledge of suspected Medicaid fraud, you must act fast. One significant difficulty with whistleblower cases is the brief statute of limitations. Failure to meet the statute of limitations provisions are a favorite for the defense in cases of Medicaid fraud and can ruin your chances for success.
The California Whistleblower Statute provides for a three-year statute of limitations. The clock starts at the time the employee discovers their employee is going to retaliate, rather than when the retaliatory act actually occurs. Federal statutes of limitations also apply in filing whistleblower cases and anti-retaliation claims and can be as brief as 30 days.
A CFCA action must be filed within three years of the date of “discovery” of the fraudulent act (discovery by the Attorney General or prosecuting authority with jurisdiction) and not more than 10 years after the date the false claim was submitted to the government for payment. Under the federal False Claims Act, the six year statute of limitations begins when the fraudulent act became “known or reasonably should have become known (31 U.S.C. § 3731).”
The CFCA contains a “first to file” provision and an “original source” provision. An individual with information on Medicaid fraud must therefore act fast. If the information is reported by someone else, leaked to the public or doesn’t meet the statute of limitations, eligibility for the whistleblower cash award is lost. Since months to years of investigation and preparation can be required before a whistleblower case gets underway, it is crucial that health care employees report Medicaid fraud as soon as possible.
3 Easy Steps to Help you Decide
Whether You Should Report Medicaid Fraud
Reporting suspected Medicaid fraud as soon as you suspect illegal activity is the key to establishing your place as whistleblower and protecting yourself from adverse employer actions. Hesitation can result in lost opportunity, adverse employment concerns and a failed case. Contact the Medicaid Fraud Hotline now to protect your rights and secure your claim.
Blow the Whistle on Medicaid Fraud and Maximize Your Cash Award