Whistleblower and Qui Tam

Upcoding, in plain terms, means making patients look sicker on paper than they are. Medicare pays a Medicare Advantage plan a fixed amount per enrollee each month, and that amount rises with every diagnosis on the patient’s record, so a diagnosis the patient does not have, or one that no physician ever treated or documented,[...]

The Justice Department reported more than $2.9 billion in False Claims Act settlements and judgments for fiscal year 2024. Whistleblowers drove the great majority of it: relators filed 979 new qui tam suits, a record at the time, and more than $2.4 billion of the $2.9 billion came from qui tam cases. Relators received over[...]

Yes. While the Middle District of Florida decision back in September 2024 held that FCA relators are unappointed “officers of the United States” in violation of Article II, it is vital to take note that the decision is just a single district court ruling that binds no one else. Every federal court of appeals to[...]

In Murray v. UBS Securities, LLC, 601 U.S. 23 (2024), a unanimous Supreme Court held that Section 806 of the Sarbanes-Oxley Act (“SOX”) contains no “retaliatory intent” requirement. Specifically, a whistleblower seeking to invoke the anti-retaliation protections of SOX must prove that their protected activity was a contributing factor in the employer’s unfavorable personnel action,[...]

The Criminal Division launched the Corporate Whistleblower Awards Pilot Program in August 2024 intending to reach four subject areas: crimes involving financial institutions, foreign corruption and bribery, domestic bribery and kickbacks to public officials, and federal health care offenses involving private insurers. The May 2025 expansion expanded the reach considerably by adding fraud against the[...]

False Claims Act (FCA): Since 1986, the False Claims Act has generated over $85 billion in recoveries. Whistleblowers are entitled to a percentage share of the government’s recovery under the False Claims Act as a reward for exposing an organization’s wrongdoing – also known as the “Relator’s Share.” Generally, in False Claims Act cases, a[...]

In most instances, you are not required to report internally first. For standalone qui tam cases filed under the False Claims Act, the SEC, and other agencies, there is no requirement to report the misconduct internally before going to regulators. However, there are anti-retaliation protections available for whistleblowers. SOX, the Dodd-Frank Act, the FCA and[...]

The False Claims Act (31 U.S.C. §§ 3729–3733), also called Lincoln’s Law, is the federal government’s primary anti-fraud statute. In the U.S., the False Claims Act allows private citizens to bring enforcement action against companies and individuals that commit fraud against the government. Violators can face treble damages plus penalties of $13,946 to $28,619 per[...]

You do not need to provide a complete forensic trail — your firsthand testimony is often sufficient to begin. As a starting point, your testimony explaining the nature of the fraud, the scope of the fraud, the duration of the fraud and facts about the defendant entity is valuable for building credibility for the case.[...]

False Claims Act: The first step in a qui tam case is when a whistleblower files a complaint in federal court. This is done under seal, which means the case is kept confidential for at least 60 days while the DOJ investigates, though seal periods are often extended much longer, even years. During the government’s[...]

Almost anyone with original source knowledge of fraud can file a qui tam lawsuit — employees, contractors, competitors, or even patients. A “relator” is the private person who brings a qui tam lawsuit on behalf of the United States government under 31 U.S.C. § 3730. In other words, if you have any information about misconduct[...]

The SEC and CFTC whistleblower programs, created by the Dodd-Frank Act, are award programs designed to encourage individuals to report potential securities-law and commodities-law violations to regulators with enforcement authority. The SEC has awarded over $2.2 billion to 444+ whistleblowers since 2011. In both programs, eligible individuals who voluntarily provide original information that leads to[...]