Persons who have specific personal knowledge of fraud being perpetrated against the Medicaid system may file a “whistleblower” (qui tam) lawsuit against the provider under Colorado’s Medicaid False Claims Act, C.R.S. 25.5-4-304 to 310. Suits are filed in the name of the State and are “under seal,” which means they are filed in secret and are not initially served or provided to the defendant. A prevailing plaintiff can be awarded a percentage of the recovery gained by the State if certain conditions are met.
The state will investigate the allegations in the whistleblower suit before it is served on the provider, and decide whether or not to intervene in the case. If it does, attorneys for the State will handle the case while the whistleblower participates and assists. If the State does not intervene, the whistleblower is left to press the case on his or her own. Until the case is “unsealed” by court order, the whistleblower must not reveal its existence nor discuss the case publicly.
The False Claims Act also provides a remedy for whistleblowers who are still employed by the defendant/provider, if they believe they have been retaliated against by their employer.
For more information about filing a whistleblower lawsuit contact an attorney with knowledge in this area, and see Colorado Revised Statutes 25.5-4-304 to 310.