Supervisor with WellPoint Companies of California Sued over Alleged False Audits

According to a report by North Hollywood-Toluca Lake Patch, a lawsuit against a major California-based healthcare insurer, WellPoint Companies, and one of the company’s supervisors is being pursued by a former employee, a North Hollywood man who used to work for the insurer as an auditor of Medicare records. He alleges in the suit that he was wrongfully terminated for reporting fraudulent practices within the company to management.

Other allegations include workplace retaliation, violations of the whistleblower law, and emotional distress. He did not specify the damages he seeks.

The disgruntled former auditor started out at WellPoint as a temp in August 2010. He worked his way up to a position as a Medicare senior auditor in 2011. His position with the company was terminated later that same year. His job duties included checking and organizing audits for the healthcare insurer’s payment arrangement system.

Not a month after he started his full-time position as a senior auditor, his supervisor allegedly told him to falsely backdate audits. Supposedly, any reluctance on his part was met with intimidation or indifference. The former auditor claims that he was shocked to learn how acceptable illegal auditing was in the company’s culture.

After allegedly encountering multiple instances of illegal auditing and other violations of Medi-Cal regulations, he reported the wrongdoing to the ethics and compliance department. He was fired shortly after.

If these allegations brought against WellPoint Companies and the claimant’s former supervisor are found by the court to be true, they could face severe civil penalties and prompt administrative and even criminal investigations.

Although this is technically an “employment law” case it relates to health care law since the claim is that he was wrongfully terminated for reporting fraudulent billing practices. Health care litigation is highly complex and it requires knowledge of health care laws and regulations governing Medicare, Medi-Cal and billing.

This employee lawsuit could have been minimized or prevented if there was a compliance plan that requires exit interviews before any employee leaves employment. Having former employees accuse health care organizations and professionals of fraudulent billing after they are terminated is not uncommon. It is important to have a compliance plan in place where employees agree in writing that they are responsible for reporting any suspected fraud and there is training about compliance.

If you are a business or professional facing such accusations before a lawsuit or after a lawsuit is filed, you will need the help of an experienced Los Angeles health care litigation attorney. Green & Associates have helped many clients defend against these type of accusations and state and federal lawsuits, and we can do the same for you. Call us today at (213) 233-2260.