Medical treatment in California can be very expensive, especially for those who cannot afford to pay for private health insurance. Medical bills for procedures and surgeries can add up quickly and medications are also very expensive. However, they are also necessary for many people. In order to help people who need the medical treatment, but cannot afford it, these individuals may qualify for Medi-Cal to pay for these costs.
The medical providers just bill Medi-Cal for the payments for the service they provide. However, just like most businesses, medical providers are trying to make money. Therefore, they may try to obtain compensation from Medi-Cal for services they did not provide or commit other types of fraud.
They could do this by offering gifts or other incentives to get people to participate in the Medi-Cal program. They could also charge the patient the difference between what Medi-Cal pays compared to the normal charge for the treatment. Another type of fraud is by billing for unnecessary lab tests or equipment that was never ordered and other types of unnecessary billing.
It is difficult for Medi-Cal to detect all these types of fraud though and rely on the employees at these medical facilities to report it when they know it is occurring. To help encourage this, these employees are also protected against whistleblower retaliation for reporting the fraud. If the employer did retaliate, the employee may be entitled to compensation for various types of damages they suffer as a result.
There are many medical facilities who try and make extra money through Medi-Cal fraud. This is illegal though and it is important that they are held accountable for their fraud. However, this usually means that an employee aware of the fraud needs to report it. These employees can do so without being retaliated against as well. If they are they may be able to receive money for any income they lost, emotional distress they experienced and other types of damages. These are complicated matters though and experienced attorneys may be able to guide one through it.