Fraud in the healthcare industry is sadly widespread and account for roughly 10% of all healthcare expenses in the United States. The Federal Bureau of Investigation (FBI) estimates that healthcare fraud costs the nation tens of millions of dollars each year. The Los Angeles whistleblower attorneys at Kingsley & Kingsley Lawyers represent employees who blow the whistle on healthcare fraud at hospitals, surgical centers, rehabilitation centers and other facilities that provide healthcare and related services.
What Are Some Examples of Healthcare Fraud?
Healthcare fraud can take a number of different forms, from medical billing fraud to medical device fraud. Some of the most common include:
- Performing unnecessary medical procedures to increase billings and profits
- Making fraudulent Medicare and Medicaid claims
- Changing patient records
- Taking kickbacks for patient referrals to a healthcare facility
- Making misleading or false claims about drugs or medical devices
- Any fraudulent representation by a hospital or other healthcare facility
Blowing the Whistle on Healthcare Fraud
If you work in the healthcare industry and observe or are asked to perform fraudulent acts, it is important that you meet with a medical whistleblower attorney to discuss your options such as pursuing a lawsuit or reporting the incidents of fraud to the appropriate law enforcement agency. You may also need representation from an employment lawyer who is experienced handling whistleblower cases specific to the healthcare industry to protect yourself from potential liability and retaliation by your employer.
The experienced medical whistleblower attorneys at Kingsley & Kingsley have represented a number of doctors, physician assistance, registered nurses and nurse's assistants, medical technicians and other workers in the healthcare industry in connection with their whistleblower claims.
California Whistleblower Laws Pertaining to the Healthcare Industry
We have observed that the recent coronavirus pandemic have made these whistleblower laws more important than ever. If you work in a healthcare facility, it is important to know and understand some of the specific California whistleblower laws that protect healthcare workers from retaliation when they report fraud or unsafe practices concerning patients and employees.
California Health and Safety code Section 1278.5 protects healthcare workers and staff in facilities with 24-hour or longer stays when they report unsafe patient care. If employees are terminated within 120 days of reporting the unsafe practice, they can file a whistleblower retaliation lawsuit against their employer to recover lost wages, emotional distress and potentially, punitive damages. In addition, employers may other monetary penalties.
This law specifically protects workers who report any issues relating to care, services or poor or substandard conditions in a healthcare facility. The California Legislature has worked this protection into the state's public policy specifically to make sure patients and medical staff members feel safe to notify governmental agencies about suspected unsafe patient care. This essentially means that the health facility or any entity that owns or operates the facility is prohibited by the law from discriminating against you if you report any patient care violation – whether such reporting is done internally or to a governmental entity.
Retaliation by your employer could include actions such as termination, demotion, suspension or changes to an employment contract. Even the threat of such actions will be considered retaliatory.
California Health and Safety Code Section 1250 defines "health facility" as “any facility, place, or building that is organized, maintained, and operated for the diagnosis, care, prevention, and treatment of human illness, physical or mental, including convalescence and rehabilitation and including care during and after pregnancy, or for any one or more of these purposes, for one or more persons, to which the persons are admitted for a 24-hour stay or longer."
Under this definition, a clinic or doctor's office may not qualify as a "health facility" because patients should be admitted for at least a 24-hour stay. Typically, under this law, qualifying facilities would be hospitals. While long-term or assisted living facilities such as nursing homes are not protected under this section, they are protected under Section 1432.
California Business and Professions Code Section 510 protects physicians and other healthcare providers from retaliation for protesting an administrative decision, policy or practice that adversely affects patient care. This law includes healthcare practitioners including physicians, psychologists, therapists, physician assistants, dentists and others. Employees who have been retaliated under this section are entitled to receive damages including lost wages, emotional distress, attorney's fees, court costs and punitive damages. In order to be a healthcare practitioner under California law, an employee must "engage in acts which are subject to licensure or regulation" within the state.
California Business and Professions Code Section 2056 is similar to Section 510, but specifically provides protection from retaliation for physicians and surgeons who advocate for patients' healthcare. Any individual or entity who terminates employment or a contractual relationship with a surgeon or physician for advocating for patients, violates this section of the law.
How Our Whistleblower Attorneys Can Help
Decisions and actions relating to healthcare could make the difference between life and death. When patients are not being provided appropriate care or when healthcare professionals are forced to work in unsafe conditions, employees should have the right to report that to their employer or a regulating governmental entity. Fear of retaliation should not stop them from doing so, which is why California has these laws that protect healthcare workers from retaliation.
If you have been retaliated against by your employer for reporting medical fraud or unsafe conditions in a healthcare facility, the experienced Los Angeles medical whistleblower lawyers at Kingsley & Kingsley Lawyers can help you better understand your legal rights and options. Call us to find out how we can help you.