Legal Question in Employment Law in California

I work for a healthcare provider as their medical biller. When I started working for this employer I learned that some of the things I was doing is fraudulent and that I could be charged criminally for. I told my employer and provided them proof and they told me that they would change the process. One year later there has been some progress yet I am still told to do things illegally. I have also been reprimanded for not billing their way when I do it the legal way. I have filed a fraud complaint with Medicare and they have verified that what I am doing is criminal, yet since we are a small provider nothing will probably be done. There are also so many other insurance companies that we are billing wrong for, that I am overwhelmed filing a complaint with every single one. I have been looking for a new job but I have not been able to find one. I can't just walk away and lose my only income. I understand if I do, I won't be able to receive unemployment benefits either. Its weighing heavily on me knowing that I have to go to work and knowingly break the law. I don't know what to do.


Asked on 5/29/11, 8:13 am

2 Answers from Attorneys
Robert Worth Robert J. Worth , Professional Law Corporation

If you employer takes any negative action it will constitute retaliatory misconduct if you are acting as a whistle blower. The law protects whistle blowers even when they are wrong which

Does not appear to be the case here. If you are suspended or worse, terminated for good faith reporting that you employer is violating a law you would be entitled to damages including reinstatement. I suggest that you consult with an attorney your whistle blower rights. I hope this helps.

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Answered on 5/29/11, 11:51 pm
Raven Sarnoff

In my opinion, the best thing you can do legally to protect yourself is to report the Medicare fraud to the Office of Inspector General and tell your employer IN WRITING that you have done so. You can report Medicare fraud to the OIS by phone at 1-800-HHS-TIPS (1-800-447-8477) or online at http://oig.hhs.gov/fraud/report-fraud/index.asp. It is unlawful for an employer to retaliate against an employee for reporting unlawful conduct to a government agency. If your employer were to fire you after doing so, you could sue the company for wrongful termination, and your written complaint would provide valuable evidence in your case that the employer KNEW that you complained to the government and retaliated against you for doing so.

You can also report the fraud on each private insurance company to the insurance companies themselves. However, reporting government fraud to a government agency gives rise to additional legal protections that do not arise in the private context. Thus, if you are going to report anything, report the Medicare fraud to the OIS.

Please note that this is what I believe, as an employment attorney, you should do LEGALLY in order to protect yourself and make sure if you are fired, you can prove your case. Keep in mind that, ultimately, following this advice could get you fired. Thus, practically speaking, what you should do for yourself and your financial situation is outside the scope of this attorney�s expertise, as is any potential criminal exposure you may be subject to under these circumstances.

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Answered on 5/31/11, 10:46 am


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