Healthcare employees are often the first to notice when something is wrong with the way their employer handles billing. Upcoding, unbundling, billing for services never rendered, or falsifying documentation to support Medicare reimbursements are forms of fraud that cost taxpayers billions of dollars each year—and employees who report these practices are protected by some of the most powerful whistleblower laws available. If you reported suspected Medicare fraud and your employer retaliated against you, you may have significant legal recourse.
The Laws That Protect Healthcare Whistleblowers
Several overlapping legal frameworks protect employees who report Medicare fraud:
- The False Claims Act (FCA): This federal law prohibits submitting false claims to the government and contains a strong anti-retaliation provision protecting employees who report fraud. It also allows whistleblowers to file a qui tam lawsuit on the government’s behalf and receive a portion of any funds recovered
- California’s False Claims Act: Mirrors the federal law at the state level with similar whistleblower protections and qui tam provisions
- California Labor Code Section 1102.5: Broadly protects employees who report suspected violations of law to a supervisor, HR, or a government agency
- The Anti-Kickback Statute and Stark Law: Violations of these healthcare-specific laws can also form the basis of a whistleblower report
Protection under these laws applies whether you reported internally to a supervisor or compliance officer, or externally to a government agency such as the Department of Health and Human Services Office of Inspector General.
Recognizing Retaliation After a Fraud Report
Retaliation following a whistleblower report can take many forms, including:
- Termination or constructive dismissal shortly after making a report
- Demotion, pay cuts, or removal from desirable assignments
- Sudden negative performance evaluations that did not exist before the report
- Increased scrutiny, harassment, or isolation from colleagues
- Threats, intimidation, or pressure to retract the report
The timing between the report and the adverse action is often the most telling indicator of retaliation.
What a Whistleblower Claim Can Recover
Employees who prevail on whistleblower retaliation claims may be entitled to:
- Reinstatement to their former position
- Double back pay under the False Claims Act
- Compensatory damages for emotional distress and reputational harm
- Attorney’s fees and litigation costs
- A share of government recovery in a successful qui tam action, which can range from 15% to 30% of the total amount recovered
Acting Quickly Matters
Whistleblower claims have filing deadlines that vary depending on the legal theory and agency involved. Consulting an attorney promptly after retaliation occurs preserves your options and ensures evidence is documented before it becomes unavailable.
If you reported Medicare billing fraud at your healthcare employer and faced retaliation as a result, PLBH can help you understand the protections available to you and pursue the remedies you deserve. Call (800) 435-7542 to speak with a California employment attorney today.