Is Your Colorado Health Care Employer Participating In Medicaid Billing Fraud?
Colorado Medicaid Fraud is the inappropriate use of state funds designated for individuals in need in order to profit financially. False statements, misrepresentation, kickbacks and billing for unnecessary costs are just a handful of schemes health care providers or suppliers may devise to try and cheat state health care programs out of valuable funds. These stolen taxpayer dollars not only result in an increase in overall healthcare costs, they also can impact patient care when providers make decisions based on financial gain over patient need.
Several Colorado statutes and regulations are in place to aid in the fight against Medicare Fraud. Private individuals employed by the health care industry are the state’s number one resource for detecting fraudulent activity. The government supplies powerful protections and substantial financial incentives for whistleblowers willing to report original knowledge of illegal activity.
Find out if your information on Medicaid Fraud qualifies you for a whistleblower cash award. Call now for a free, instant and confidential case evaluation.
Review the Various Types of Medicaid Fraud
Reporting Colorado Medicaid Fraud
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What Colorado Whistleblower Laws Cover Reporting Medicaid Fraud?
The Colorado Medicaid False Claims Act, C. R. S. §§25.4-4-303.4 et seq., makes it illegal for persons to knowingly submit false claims to Colorado Medicaid and other health care programs under the Colorado Medical Assistance Act. Unlike the federal False Claims Act, the Colorado Medicaid False Claims Act (CMFCA) is Medicaid specific and does not govern fraud outside of the health care industry.
The CMFCA contains qui tam provisions that allow private citizens to bring suit on behalf of the State and share in a portion of any government recovery. The CMFCA also provides anti-retaliation protections and offers damages for whistleblowers who suffer retaliatory action due to reporting Medicaid fraud.
Penalties for violating the CMFCA include:
- Treble damages the state of Colorado sustained due to the fraudulent activity
- Civil penalties of between $5,000 to 10,000 per false claim
- Liability for the cost to bring a civil suit
Liability may be reduced to not less than twice the amount of damages if a defendant voluntarily discloses the misconduct within 30 days of obtaining knowledge of a false claim, there has been no action yet taken on the violation, and the defendant aids in the investigation (C.R.S. §25.5-4-305).
Colorado’s Public Employee Whistleblower Law, C.R.S. §§ 24-50.5-101 et. seq., provides protection from disciplinary and/or discriminatory action by public employers in response to their providing information regarding illegal actions that are not in the public interest.
Colorado’s Private Employee Whistleblower Law, C.R.S. §§ 24-114-101 et. seq., states that private sector employers may not apply disciplinary measures in response to information disclosures regarding illegal activity on the part of the employer. Under this law, the employee must make a good faith effort to report their knowledge directly to an internal supervisor or other authority prior to releasing the information to an external source.
Colorado’s Health Care Worker Whistleblower Protection Bill, C.R.S. § 8-2-123, protects employees working within the health care field from employer retaliation in response to reporting knowledge of misconduct that affects patient safety.
Whistleblowers are our nation’s first line of defense in combatting Medicaid Fraud. Health care professionals and others with knowledge of Colorado Medicaid Fraud may be eligible for a substantial cash reward and are encouraged to connect with the Medicaid Fraud Hotline now for a free, no-obligation case evaluation.
What Protections Does Colorado Law Provide For Medicaid Fraud Whistleblowers?
Though Colorado is an at-will employment state, there are several statutes that provide protection against employer retaliation for whistleblowers who chose to report an employer who has been participating in Medicaid fraud. Employer retaliation against whistleblowers is illegal in Colorado and private individuals who have experienced retaliation may file a lawsuit for damages.
The Colorado Medicaid False Claims Act (CMFCA) contains powerful anti-retaliation provisions that are put in place to remedy employees who experience workplace retaliation due to reporting Medicaid fraud. Individuals who experience job loss, demotion, suspension, harassment, threats, promotion denial or other discrimination in response to their disclosure of information regarding illegal activity to the State or furtherance of a CMFCA action are entitled to all damages required to “make the employee whole.”
Under the CMFCA, potential anti-retaliation remedies include:
- Reinstatement of employment in a similar position of seniority
- Double the amount of back pay plus interest lost due to retaliatory action
- Reasonable attorneys’ fees and other applicable litigation costs
- Other “special” damages resulting directly from the retaliation
Similar remedies are available under Colorado’s Public Employee Whistleblower Law, Colorado’s Private Employee Whistleblower Law, and Colorado’s Health Care Worker Whistleblower Protection Bill, where applicable. These laws prohibit the following actions by employers in response to an employee blowing the whistle on Medicaid fraud within the workplace:
- Pay reduction
- Loss of supervisory roles
- Promotion denial
- Other discriminatory acts
Under Colorado’s Public Employee Whistleblower Law, any state employee who is retaliated against by their employer may file a written complaint with the Colorado state personnel board for job reinstatement, back pay and other applicable damages. If the written complaint is denied, the employee may then bring a civil suit to recover damages.
Under Colorado’s Private Employee Whistleblower Law, private employees may file a civil lawsuit for damages without having to go through an initial written complaint procedure.
What Cash Award Amounts Are Offered for Reporting Colorado Medicaid Fraud?
Under the CMFCA, whistleblowers whose cases are not joined by the State may proceed with the assistance of their own legal team. In the instance that the State of Colorado decides to intervene, the whistleblower is entitled to between 15-25% of the State’s recovery resulting from a settlement or verdict. If the State chooses not to intervene and the whistleblower proceeds with his or her private legal team, the cash award is increased to between 25-30% of the recovery (CRS § 25.5-4-306(4)).
On top of these awards, whistleblowers in both situations are eligible to collect reasonable expenses, reasonable attorney’s fees and costs.
If the information provided by the whistleblower is based on public knowledge and the whistleblower is not the original source of the information, or if the whistleblower planned and initiated the fraudulent activity, awards may be reduced to no more than 10% of the recovery (CRS § 25.5-4-306(4)).
It is estimated that up to 10% of all Medicaid claims submitted by health care providers and suppliers are excessive or fraudulent. This is precisely why the government is willing to pay substantial cash awards to whistleblowers for exposing misconduct. Colorado Whistleblower Laws and the Colorado Medicaid False Claims Act are highly effective means of fighting fraud and recovering taxpayer dollars, but only if health care workers with knowledge of misconduct are willing to come forward. Contact the Medicaid Fraud Hotline Now to learn whether you have a case and are eligible for a cash award.
What is the Statute of Limitations on Reporting Colorado Medicaid Fraud?
Under the Colorado Medicaid False Claims Act, an action may not be brought:
- More than 6 years after the alleged fraudulent act OR,
- More than 3 years after the date when the material facts of the case should have become known
- Later than 10 years after the fraudulent act occurred.
In addition, the CMFCA has a “first to file” bar, meaning the first to report original knowledge of Medicaid Fraud will be designated as the only person eligible to receive a whistleblower cash award.
To obtain protections under Colorado’s Public and Private Employee Whistleblower Laws, employees must file a written complaint within 30 days of the retaliatory incident.
3 Easy Steps to Help you Decide
Whether You Should Report Medicaid Fraud
If you have knowledge of Medicaid Fraud in the State of Colorado, contact the Medicaid Fraud Hotline or fill out the online report form. Act fast. First to file provisions mean only the first to report an incident is eligible for a cash award. Statutes of limitations may apply.
Huge Cash Rewards Paid for Reporting Colorado Medicaid Fraud