A former contractor for Molina Healthcare filed a whistleblower lawsuit against the company, accusing them of committing healthcare fraud.

According to the healthcare fraud lawsuit, Molina breached its Medicaid contract and then failed to disclose that it was not actually providing certain required services to its nursing home patients in Illinois. The whistleblower claims that the cover-up of this healthcare fraud lasted for two years.

Molina Healthcare, based in Long Beach, Calif., provides insurance—including Medicaid—to nearly 4 million people in 13 states and Puerto Rico. In Illinois specifically, the center of this litigation, the company serves 223,000 members.

The whistleblower healthcare fraud complaint was sealed up until mid-November, and a number of related documents remain sealed.

The healthcare fraud lawsuit was filed as a whistleblower case by the founder of a contractor who formerly worked with Molina, General Medicine P.C.

A program known as “SNFist” provides skilled nursing home patients with visits from either a doctor, a physician’s assistant, or nurse practitioner at least once every two months. These visits are intended to help stay on top of patient illnesses and other medical problems before they reach a critical state.

In accordance with this program, Molina hired General Medicine as a contractor to provide these required SNFist services in 2014. However, after just four months, Molina allegedly stopped paying General Medicine for these services. A few months later, in April 2015, after the payments stopped coming in, General Medicine stopped providing these services entirely, the complaint alleges.

According to the healthcare fraud lawsuit, Molina Healthcare no longer paid for or provided SNFist services, but continued claiming to Medicaid that it was providing them, and thus continued to receive Medicaid payments for them.

This healthcare fraud lawsuit is not Molina’s only issue. In May 2017, Molina’s board fired its CEO and CFO over poor company performance.

Filing a Healthcare Fraud Whistleblower Lawsuit

If you have witnessed healthcare fraud or other fraud against the government committed by your employer or former employer, you may be able to file a lawsuit. Whistleblowers are individuals who take action on behalf of the federal government, coming forward because they have witnessed something they don’t feel right about.

Whistleblowers can file litigation while they’re still working at the company they’re accusing of fraud, or after they’ve left. Those who choose to bring the attention of the federal government to fraud committed by their current employer may be worried about retaliation for blowing the whistle, but there are laws in place to protect whistleblowers in these situations.

For their part in the litigation, whistleblowers are generally awarded a substantial chunk of money from the lawsuit, usually between 15 and 30 percent. In major whistleblower healthcare fraud litigation cases, this can result in an award of hundreds of thousands or even millions of dollars.

If you have witnessed healthcare fraud or other fraud against the government, you may be able to file a whistleblower lawsuit (sometimes known as a qui tam lawsuit) on behalf of the government.