Q: investigation and discovery of identities - CA Healthcare FCA
The legally actionable material facts are: fraudulent referral to hospice by hospital with non-existent terminal disease recorded on admission to hospital, and consequent 6-months of fraudulent hospice care, presenting evident and provable basis for the CA FCA complaint .
In such situation: is investigation and discovery of identities of actual individual wrongdoers and fake records is prerogative of department of justice? Info is in the Defendants' possession that they would not disclose voluntarilty.
A:
Under the California False Claims Act (CFCA), which is similar to the federal False Claims Act but specific to California, private individuals or entities can bring a qui tam action on behalf of the state against those who have allegedly defrauded the state's healthcare system. In the situation you described, the following points are relevant:
1. Investigation: Once a qui tam complaint is filed under the CFCA, the California Attorney General's Office has the prerogative to investigate the allegations. The complaint is filed under seal, allowing the government time to investigate the claims without the defendant's knowledge.
2. Discovery: During the investigation, the Attorney General's Office has the authority to issue subpoenas and conduct discovery to gather evidence, including the identities of individual wrongdoers and any falsified records. This discovery process can be used to obtain information that the defendants may not voluntarily disclose.
3. Government intervention: After investigating, the Attorney General's Office can choose to intervene in the case and take over the litigation, or it can decline to intervene, allowing the qui tam plaintiff (known as the "relator") to proceed with the litigation independently.
4. Defendant's disclosure: If the government declines to intervene, the complaint is unsealed, and the defendants are served with the complaint. At this point, the defendants would be required to respond to the allegations and may be compelled through the regular civil discovery process to disclose relevant information, including the identities of individuals involved and any records related to the alleged fraud.
In summary, the investigation and discovery of the identities of wrongdoers and any falsified records are initially the prerogative of the California Attorney General's Office after a qui tam complaint is filed. If the government declines to intervene, the qui tam plaintiff can proceed with the litigation and use the civil discovery process to obtain relevant information from the defendants.
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