Healthcare fraud is the largest category of recoveries under the False Claims Act. Whistleblowers who provide original, firsthand information about Medicare or Medicaid fraud may be entitled to 15–30% of the funds recovered.
Submit Your InformationYour information should come from direct knowledge, such as billing records, coding logs, internal communications, or firsthand observation of how claims were submitted to Medicare or Medicaid.
False Claims Act qui tam cases are filed under seal, meaning the complaint stays confidential while the government investigates and decides whether to intervene.
If the case leads to a government recovery, the whistleblower (called a "relator") is entitled to between 15% and 30% of the total amount recovered.
Claims submitted for office visits, tests, equipment, or procedures that were never actually provided to the patient, sometimes called phantom billing.
Billing a routine visit or procedure under a higher-reimbursement code than what was performed, or billing the individual components of a procedure separately to inflate the total charge.
Payments or other incentives exchanged for patient referrals in violation of the Anti-Kickback Statute or the Stark Law's restrictions on physician self-referral.
Ordering tests, imaging, hospital admissions, or procedures that are not medically necessary in order to generate additional billings.
Billing for homebound or hospice patients who do not qualify for those benefits, fabricated physician certifications, and services billed but never delivered.
Billing for prescriptions never dispensed, improper drug switching, compounding pharmacy schemes, and kickbacks involving pharmacy benefit arrangements.
Healthcare fraud is the largest single category of recoveries under the False Claims Act. Whistleblowers whose original information leads to a recovery are entitled to between 15% and 30% of the funds collected.
For Medicare and Medicaid fraud claims with estimated damages exceeding $1M
This intake only handles reports from insiders about fraud by an organization, so we are not the right fit for this matter. The agencies below accept reports like yours directly.