WHISTLEBLOWER ATTORNEYS

“Whistleblower fraud” under the False Claims Act can include: (1) submitting false invoices or billing the United States for goods or services not provided or not medically necessary; (2) receiving federal funds or benefits not earned; (3) violating material terms of a government contract (e.g., substituting substandard products or unqualified staff); or (4) using false statements to avoid paying money owed to the government (e.g., customs duties or overpayments).

Healthcare billing (Medicare/Medicaid/Tricare), defense and other government contracting/procurement, financial services, and manufacturers/importers involved in customs-duty evasion. Workplace safety issues generally fall under OSHA whistleblower protections, not the FCA.

Any individual or non-governmental entity with non-public, specific information about fraud against the federal government may file a sealed qui tam complaint as a “relator,” regardless of job title or industry.

If you can answer “yes” to most of the following, you may have a viable whistleblower claim under the FCA:

• The conduct billed the federal government or caused it to pay money it should not have.

• At least some fraud occurred within the last six years.

• The government’s loss is substantial (our firm typically looks for cases with losses of $500,000+ to justify the cost/complexity, but this is a screening guideline, not a legal threshold).

• You have documents, data, or first-hand knowledge.

• The allegations are not already public and not previously disclosed to the government by others.

Upcoding, billing for services not rendered or not medically necessary, kickbacks disguised as marketing or consulting, product substitution, failure to meet contract specifications, false “Buy American” or country-of-origin certifications, false cybersecurity or safety attestations, and customs misclassification to avoid duties.

Only the first relator to file a qualifying case based on a particular fraud scheme may proceed. Speed and thorough preparation are decisive.

Your counsel drafts a detailed complaint and a confidential disclosure statement and files the case under seal in federal court. The seal allows the Department of Justice and relevant agencies to investigate before the defendant learns of the case.

The government investigates. You may meet with agents and attorneys, supply documents, help explain data, or assist in targeted steps. Do not discuss the case publicly or at work. The seal period can be lengthy; years are not unusual.

After investigating, the government may: (1) intervene and take the lead; (2) decline, allowing you and your counsel to litigate; or (3) seek partial intervention. Intervention generally increases the odds of recovery, but strong declined cases can also succeed.

If the government intervenes, the relator award is generally  15%–25% of the government’s recovery. If the government does not intervene and you proceed, the award can be up to 30%. The percentage depends on the quality of your information, your assistance, the significance of the case, and any involvement in the misconduct.

Under the FCA, the government may recover treble damages (three times its loss) plus civil penalties per false claim. In large healthcare or defense cases, recoveries can reach hundreds of millions or more.

Expect a multi-year timeline. The seal phase alone can be extended multiple times while the government investigates and negotiates.

First-hand testimony helps, but documents and data are critical. These can include emails, invoices, claims data, purchase orders, testing records, certifications, or import entries. Coordinate collection with counsel to avoid privacy, HIPAA, trade secret, or computer access violations.

No. Purely private-payer schemes fall outside the FCA. Fraud must involve federal funds (e.g., Medicare, Medicaid, Tricare, VA, FEHBP, or federal contracts/grants).

The FCA’s public disclosure bar can block copycat suits based on public information, unless you qualify as an original source with independent knowledge that materially adds to what is public.

During the seal period, filings are confidential. If the case proceeds, your identity typically becomes public when the seal lifts or the case resolves. Courts can allow limited redactions or protective orders, but anonymity is rare.

Participation does not automatically disqualify you. It may reduce your award and can raise separate legal risks. Early, candid consultation with counsel is essential.

Those issues are usually addressed under OSHA’s whistleblower protections or other statutes, not the FCA. Separate deadlines and procedures apply.

FCA practice is resource-intensive and strategic. You need counsel who can rapidly investigate, assemble a persuasive disclosure for DOJ, manage parallel agency interests, and, if necessary, litigate a declined case to judgment.

Preserve evidence, record a factual chronology, avoid internal confrontations or public disclosures, and speak with experienced FCA counsel before taking any further steps.