Insurance Fraud Victims Who Get no Justice from State May Sue Fraud Perpetrators on Behalf of State

Read the full article at https://www.linkedin.com/pulse/when-state-fails-prosecute-insurance-fraud-insurer-zalma-esq-cfe and at https://zalma.com/blog plus 3550 posts. 

The California Legislature created the Insurance Fraud Protection Act (IFPA) to combat insurance fraud. However the fraudulent billing practices which was brought in the name of the state, not the insurer.

In State Of California ex rel. Aetna v. Pain Management  2d Crim. No. B299025, Court Of Appeal Of The State Of California Second Appellate District Division Six (December 21, 2020).

ZALMA OPINION

If an insurer is the victim of a fraud by an individual, or with regard to multiple claims, as were the plaintiffs, faced with inaction or total lack of interest of state police or prosecutorial agencies the California IFPA allows the filing of a whistleblower action in the name of the state. State Insurance Departments are inundated with reports of suspected insurance fraud and do not have the staff to investigate and prosecute all reported. It is incumbent on insurers in states like California with an IFPA to proactively work to defeat fraud as did the plaintiffs by bringing a qui tam case in state courts.