California Medi-Cal Whistleblowers

Medi-Cal whistleblowers may be entitled not only to federal whistleblower rewards, but also California state whistleblower rewards.

California’s version of Medicaid is called “Medi-Cal.” The way Medicaid works is that the federal government provides funding or incentives to the states to set up free health care programs for the poor, disabled, or other state citizens who need help. Some states have set up more robust Medicaid systems than others. California’s Medicaid program, Medi Cal, is relatively expansive in its coverage. According to California Disability Benefits 101, there are 90 eligibility categories in California that may qualify Californians for enrollment in Medi-Cal. The program covers the poor, disabled, elderly, and those with very high medical costs (e.g., certain types of cancer patients).

Because Medi-Cal is a joint state and federal program, healthcare providers who knowingly break Medicaid rules or Medi-Cal regulations may be liable under both the federal False Claims Act and the California False Claims Act. Under both whistleblower laws, a qui tam whistleblower can file a qui tam lawsuit in the name of the government (federal or state) to recoup damages in the amount of three times the amount of funds defrauded, plus civil penalties of up to $22,000 for every false or fraudulent claim for reimbursement from Medi-Cal. These civil penalties can add up quickly.