In 2016 alone, healthcare whistleblowers received over $52,677,000 in cash rewards for helping the government recover nearly $368.7 million dollars in stolen taxpayer dollars.

Yes, you did the math right. Whistleblowers pocketed 14% of the total amount the government was able to recover from United States fraudsters. Why does the government pay whistleblowers so well? Better yet, could you eligible for a million-dollar whistleblower cash award?

California Medicaid Medicare Fraudsters Steal $500M Plus from Taxpayers Each Year

California Medicaid (Medi-Cal) is the largest Medicaid program in the nation, carefully distributing California taxpayer dollars to help provide much needed health care services for over 11.4 million low-income individuals – including families with children, seniors, disabled, foster care, pregnant women and those with long-term care needs for diseases like tuberculosis, breast cancer and HIV/AIDS.

Total California Medicaid spending exceeds $50 billion annually. Tragically, more than $500 million of that amount goes into the pockets of corrupt fraudsters.

When dishonest health care professionals attempt to cheat California Medicaid and Medicare for a profit, the costs of California health care skyrocket, the quality of patient care decreases and every California resident suffers.

Government programs like the California Medicaid Fraud Control Unit and the U.S. Medicare Fraud Strike Force focus their initiatives on investigating and prosecuting cases of fraud and recovering stolen taxpayer dollars. But government resources used to sniff out and detect each and every case of California health care fraud are limited. This is where California whistleblowers come in.

Government Pays California Health Care Employees to Fight Fraud as Whistleblowers

Whistleblowers are the government's primary tool for inside knowledge on health care fraud, and the government pays big dollars for information that leads to successful government recovery. These important individuals are made up of physicians, nurses, pharmacists, EMT's, billing clerks, dentists, health care technicians, medical device manufacturers, and other health care professionals who have access to the daily routines of healthcare-related facilities.

Their unique access to coding, diagnoses, treatment plans, medical records, and billing statements puts them on the front line when it comes to combatting health care fraud.

Several types of behavior can constitute fraud. To name a few:

• Corrupt physicians requesting a costly treatment on a healthy patient to rack up the bills.
• Hospitals charging for services or prescriptions that they never provided or are of a substandard quality than what they billed for.
• Nursing homes offering cash incentives or season tickets to 49ers games in exchange for patient referrals.
• Clinics enforcing billing policies that amount to upcoding, unbundling or double billing.
• Physicians allowing unqualified technicians to dispense or sign prescriptions to save time.

Each time one of these activities occurs and the institution or person submits a bill to Medicare or Medicaid – MediCal for that activity, that bill becomes what is called a “false claim.” Companies or individuals continuing fraudulent behavior over several months or years can end up submitting thousands of false claims.

False Claims Act Offers Whistleblower Cash Awards and Anti-Retaliation Protection

Under the whistleblower provisions of the federal and state False Claims Acts (FCA), when a whistleblower's knowledge leads to recovery of government funds, the whistleblower is entitled to between 15% and 30% of the total recovery amount.

Because individuals or agencies who violate the federal FCA are penalized between $10,781.40 and $21,562.80 PER false claim, plus three times the amount of damages and any costs of action brought to recover the penalty or damages, cash whistleblower awards often fall in the hundreds of thousands to millions of dollars range.

Whistleblowers need not prove that the agency or individual intended to defraud the government. The only requirement is that the fraudster possesses “actual knowledge” of the relevant information and is acting with deliberate ignorance or reckless disregard of the truth or falsity of that information.

Even if you merely suspect fraud is occurring in your place of business, you may be eligible for the whistleblower cash award.

True heroes when it comes to fighting health care fraud, whistleblowers risk judgment by coworkers and superiors and even their careers in an effort to make things right, bring corrupt health care professionals to justice, and protect the quality and integrity of patient care. Because the government values the whistleblower and their efforts immensely, the FCA provides protections for whistleblowers against employers who attempt to retaliate against them.

Employees who experience harassment, denial of promotion, demotion, firing or threats after reporting fraud are entitled to damages – including three times the amount of any wages lost, interest on those lost wages, job reinstatement and any other special damages required to make that employee whole.

How Does A California Health Care Worker Become a Whistleblower?

Do you suspect your California employer of Medi-Cal or Medicaid fraud? See if you're eligible for a whistleblower reward.

The vital first step is to contact a California whistleblower lawyer. The FCA asks private citizens with knowledge of fraud against a government program to file a “qui tam” lawsuit on behalf of the government.

Only the first to file a report on each case of fraud is eligible to collect the whistleblower cash award. Therefore, to solidify your role as a whistleblower, it is crucial that you connect with a California whistleblower lawyer as soon as you suspect fraud.

The whistleblower lawyers at Tully & Weiss are happy to discuss your case with you and determine your cash reward eligibility in a free and fully confidential case evaluation. If you are a health care professional working in California's Bay Area, Contra Costa County, Alameda County or other California location and suspect your employer is submitting false claims to Medi-Cal or Medicare, call Joseph Tully to learn your options and determine your next steps.