California Insurance Fraud Whistleblower Cases
The California Insurance Frauds Prevention Act (“CIFPA”) allows members of the public to file private whistleblower/qui tam suits against anyone who commits insurance fraud in the State of California. Cal. Ins. Code § 1871.7. There have been several large whistleblower settlements under the CIFPA: against Sutter Health ($46 million for alleged double billing of anesthesia services), Bristol Myers Squibb ($30 million for allegedly defrauding health insurers by paying kickbacks) and Warner Chilcott ($23 million to settle allegations that drug marketing program violated CIFPA). The California whistleblower attorneys at Evans Law Firm, Inc. represent whistleblowers with information of insurance fraud being committed in the State of California. If you have information of insurance fraud committed in California, call us today at (415)441-8669.
Other examples of insurance fraud covered by the CIFPA include:
- Fraudulent billing or overbilling of health insurance companies by hospitals and medical specialists
- Billing of auto insurance providers by auto repair shops for services not provided and/or parts not installed
- Underreporting of total people employed by employers attempting to lower workers’ compensation insurance rates
- Submitting multiple insurance claims for the same service rendered or part replaced.
In a CIFPA whistleblower case, it is not necessary that the government suffer harm as a result of the fraud. Policyholders and the public suffer from insurance fraud so individuals who sue fraudulent actors under the CIFPA are acting on behalf of themselves and fellow policyholders as well as for the State of California. Any “interested person” can file a civil suit in the name of the State of California. Cal. Ins. Code § 1871.7(e). See People ex rel. Allstate Ins. Co. v. Muhyeldin, et al., Case No. B150524 (Ct. App. Sept. 18, 2003) (statute allows persons to sue for any act by a defendant that violates Section 1871). The burden of proof on relator in a CIFPA is a preponderance of the evidence. People ex rel. Allstate Ins. Co. v. Muhyeldin, et al., Case No. B150524 (Ct. App. Sept. 18, 2003). A successful whistleblower is also entitled to attorneys’ fees and costs for bringing suit. Cal. Ins. Code § 1871.7(g)(1)(A)(iii)(I) ( “The person bringing the action, regardless of whether that person paid money to the defendants as part of the acts alleged in the complaint, shall first receive the amount the court determines is reasonable for attorney’s fees, costs, and expenses that the court determines to have been necessarily incurred.”)(emphasis added).
A CIFPA complaint and all related evidence are filed under seal in the Superior Court and served on the local district attorney and California Insurance Commissioner, who have 60 days to decide whether or not to intervene in the case. Cal. Ins. Code § 1871.7(e)(2). If either the district attorney or the commissioner decides to intervene, government attorneys may take over and lead the prosecution, or they may allow the relator to continue to do so and serve in a supportive role. Cal. Ins. Code § 1871.7(f)(1). In this scenario, the relator would be entitled to collect between 30 and 40 percent of all subsequent recoveries from the defendant. Cal. Ins. Code § 1871.7(g)(1)(A)(iii)(IV). If the government declines to intervene, the relator would have the option of proceeding with the case alone, and would be entitled to between 40 and 50 percent of any eventual recovery. Cal. Ins. Code § 1871.7(g)(2)(A). If the Court determines that the relator’s allegations were based on public information, the relator would receive a maximum of 10 percent of the eventual recovery. Cal. Ins. Code § 1871.7(g)(1)(B). The statute of limitations for bringing an action under the California Insurance Frauds Prevention Act is 8 years. Cal. Ins. Code § 871.7(l)(2). An employer cannot retaliate against you for bringing an action under the Act. Cal. Ins. Code §1871.7(k).
In addition to cases under the California Insurance Frauds Prevention Act and False Claims Act, our California whistleblower attorneys also handle whistleblower cases before the Internal Revenue Service (IRS) regarding tax avoidance schemes and before the Securities and Exchange Commission (SEC) and Commodity Futures Trading Commission (CFTC) in securities and investment fraud cases and in cases brought under the Financial Institutions Reform, Recovery and Enforcement Act of 1989 (“FIRREA”) for bank fraud. If you or a loved one has information regarding State or federal false claims, offshore tax avoidance schemes against the IRS, or securities fraud in violation of SEC and CFTC regulations, contact Ingrid M. Evans and the other California whistleblower and false claims attorneys at Evans Law Firm at (415) 441-8669, or by email at <a href=”mailto:firstname.lastname@example.org”>email@example.com</a>. Our attorneys have experience with complex financial contracts and large insurance companies. We can help guide your case through a jury trial or toward an equitable settlement. We also handle cases involving physical and financial elder abuse, nursing home abuse, whole life insurance and universal life insurance, and indexed, variable, and fixed annuities.