The California Insurance Fraud Prevention Act (“CIFPA”), Ins. Code §§ 1871, et seq., is an anti-fraud statute applicable to all types of insurance fraud. The CIFPA is a broad reaching statute designed to prevent and punish fraud, specifically insurance fraud through imposing significant penalties and provides for recovery of damages, attorneys’ fees and costs, and a share of the penalties imposed by the successful whistleblower.
Two unique pieces of the CIFPA were discussed in State ex rel. Wilson v. Super. Ct. (2014) 227 Cal. App. 4th 579: (1) what constitutes a “fraudulent claim” and (2) the prohibition on employing “runners, cappers, [or] steerers.”Read More ›
You may be wondering if the value of your old and dusty gift certificate is still valid. In California, it is.
Under California law, it is unlawful to sell a gift certificate to a purchaser that contains an expiration date. See Cal. Civ. Code § 1749.5. Simply put, a gift certificate sold without an expiration date is valid until redeemed or replaced. Cal. Civ. Code § 1749.5(b). A similar federal law prohibits expiration periods shorter than five years. See Electronic Funds Transfer Act (the "EFTA"), 15 U.S.C. § 1693 et seq., and the Credit Card Accountability Responsibility and Disclosure Act (the "CARD Act"). These laws apply to in-store sales and also to sales on the Internet. These prohibitions also apply to both goods and services.Read More ›
Last week, court documents were unsealed in the Eastern District of Texas laying out serious allegations of fraud against True Health Diagnostics, LLC. The documents arise from a failed attempt by True Health to lift a freeze on Medicare payments put in place against it based on suspicions of serious fraud. The documents include the written Declaration of a Special Agent from the Office of Inspector General, United States Department of Health and Human Services. According to the Special Agent, Jack Geren, True Health arose out of the ashes of another laboratory company called Health Diagnostic Laboratory, Inc. (“HDL”), which was “driven out of business as a result of pervasive healthcare fraud.”Read More ›
PG&E is on probation for its six felony convictions related to the 2010 San Bruno gas pipeline explosion, which killed 8 people, injured 58 and destroyed 38 homes. U.S. District Judge William Alsup is overseeing PG&E’s probation. As part of the probation proceedings, Judge Alsup has found PG&E violated its criminal probation by failing to notify a probation officer of a criminal investigation, prosecution and settlement with the Butte County District Attorney’s Office over its role starting the 150-acre Honey Fire in October 2017. The probation proceedings are on-going and Judge Alsup is considering forcing the utility to take far-reaching reform action, such as adherence to a stringent wildfire prevention program.Read More ›
In a decision of first impression in the state and federal appellate courts throughout the country, the Virginia Supreme Court issued an opinion in a case filed by CPM in 2007, Commonwealth v. Commonwealth ex rel. Hunter Laboratories, LLC (Va., Aug. 9, 2018, No. 170995) 2018 WL 3768538, holding that the whistleblower’s award under Virginia’s false claims act must be calculated based on the total amount of the settlement of a qui tam case, not just the portion retained by the state.Read More ›
Part 6: Are There Any Downsides to Becoming a Whistleblower? The Whistleblower Facts of LifeRead More ›
“Sunlight is said to be the best of disinfectants; electric light the most efficient policeman.”
– Justice Louis Brandeis”
Investors need to be aware of efforts underway to undermine their ability to redress corporate fraud. The Securities Exchange Commission (SEC) is contemplating a highly controversial change to securities policy which would allow companies to block securities class actions, which are often the only way that defrauded investors can be made whole.Read More ›
Part 5: Whistleblower RewardsRead More ›
In a divided opinion, the Sixth Circuit Court of Appeal overturned a lower court order dismissing a $35 million whistleblower suit against Brookdale Senior Living Communities. The suit was filed by a former employee of Brookdale who was tasked with reviewing Medicare claims prior to their submission. The whistleblower alleged that it was Brookdale’s policy to enroll as many residents as possible in home health care services that were billed to Medicare, even when the treatments were not medically necessary. She also alleged that Brookdale submitted claims to Medicare without obtaining the required physician certification of need, or that Brookdale obtained the certifications after the fact.Read More ›
Part 4: Who Can Be a Qui Tam Plaintiff? And What Is the Basic Process?Read More ›