Discovering that your employer may be engaging in healthcare fraud can place you in a difficult position. On the one hand, you may want to protect yourself, other patients, and public programs like Medicare and AHCCCS (Arizona’s Medicaid system). On the other hand, however, you may worry about your job security and whether speaking up will put you at risk.
Healthcare fraud is taken very seriously under both federal and Arizona law. If you suspect wrongdoing, you have legal options to report it and may even be protected from retaliation.
What Counts as Healthcare Fraud in Arizona?
Healthcare fraud generally occurs when a provider knowingly submits false or misleading information to obtain payment for services.
Some common examples include:
- Billing for services that were never provided
- Upcoding, or charging for a more expensive service than what was performed
- Providing unnecessary medical treatments for profit
- Double billing or billing multiple insurers for the same service
- Falsifying patient records to justify claims
- Accepting or giving kickbacks for patient referrals
Arizona’s criminal code (A.R.S. § 13-2310) covers fraud schemes, and both state and federal agencies investigate these violations. Penalties can involve fines, restitution, loss of medical licenses, and prison sentences.
Steps You Can Take if You Suspect Fraud
If you believe your employer is committing healthcare fraud, there are several steps you can take to protect yourself and report the issue:
- Document what you observe. Keep detailed records of things like suspicious billing and treatment practices/instructions you have received.
- Review compliance policies. Some healthcare organizations have internal compliance hotlines or procedures for reporting concerns.
- Report to authorities. You can contact state agencies such as the Arizona Health Care Cost Containment System (AHCCCS) Office of Inspector General, or federal agencies like the U.S. Department of Health and Human Services Office of Inspector General.
- Consult with an attorney. Before taking action, it may help to speak with an Arizona employment or whistleblower lawyer to understand your rights and potential risks.
Acting quickly can protect you and help prevent further harm to patients and public programs.
Whistleblower Protections in Arizona
Many employees hesitate to report fraud because they fear retaliation. However, Arizona law, along with federal statutes like the False Claims Act, offers whistleblower protections.
Employers are generally prohibited from firing, demoting, harassing, or discriminating against an employee who reports suspected fraud in good faith. If retaliation does occur, you may have the right to file a lawsuit for relief such as reinstatement and financial compensation.
In addition, under the federal False Claims Act, whistleblowers who help expose fraud against government programs may be entitled to a financial reward if the government recovers money as a result of the case.
Why You Should Seek Legal Help in These Circumstances
Reporting healthcare fraud can be complicated. You might be unsure whether what you’ve observed qualifies as fraud or how to report it appropriately, for instance.
An experienced Arizona employment law attorney can:
- Review the facts and determine whether fraud likely occurred
- Explain your rights under state and federal whistleblower laws
- Guide you through safe reporting procedures
- Represent you if your employer retaliates against you
- Help you pursue a whistleblower reward in a False Claims Act case
By working with a lawyer who’s qualified to handle your case, you can act responsibly while protecting yourself from unnecessary legal risks.
Contact the Arizona Employment Law Attorneys at Houk Employment Attorneys for Legal Help
If you think your employer may be committing healthcare fraud, it’s important to know that you have rights and options. Fraud in the healthcare system can lead to significant harm, but the law gives you ways to report it safely and receive legal remedies.
Setting up a consultation with an experienced Arizona employment lawyer at Houk Employment Attorneys is one of the best steps you can take under these circumstances. Call today to get started.
For more information, please contact the experienced employment attorneys at Houk Employment Attorneys to schedule an initial consultation today.
Our employment law firm is conveniently located near you, with an office in Phoenix, AZ.
Houk Employment Attorneys
1850 N Central Ave Suite 2010, Phoenix, AZ 85004
(480) 569-2377
