Learn more about our whistleblowing by viewing our industry-specific FAQs.
Healthcare fraud is a top priority of the United States Department of Justice’s enforcement efforts under the False Claims Act. Over a recent four year period, 80% of the Department of Justice’s $11.4 BILLION was recovered in healthcare fraud cases. Those cases involved fraud in the Medicare, Medicaid and other taxpayer-funded healthcare programs. The primary way the Department of Justice uncovered the fraud that led to these recoveries was from reports by whistleblowers. Over that same four year period, whistleblowers received more than $1.54 billion as their share of these recoveries.
Private companies authorized to sell goods and services to the government provide billions of dollars of critical infrastructure, equipment, expertise, and much more to support a wide range of government programs that keep the government working and serving taxpayers every day. In this very competitive environment, the government contractor must execute these contracts without fraud, abuse, or misconduct.
In recent years, cases alleging tariff and duty fraud have grown in number, partly due to the increased use of tariffs as a policy tool of the United States government, and also to increased knowledge among workers in the importing and logistics businesses about available False Claims Act litigation as a tool to help stop customs fraud and customs tax evasion.
The False Claims Act applies to any government program that provides money to companies or people outside the government. In other parts of this website, we discuss how the False Claims Act applies to government-funded healthcare programs and government contracts, two significant examples of government programs covered by the Act.
The United States Department of Justice and other federal agencies have been aggressively investigating fraud related to securities, commodities, banking, and lending practices. The Department of Justice has recovered nearly $8 billion in mortgage fraud alone. Often the government uncovers the fraud thanks to reports from whistleblowers. By the end of 2020, the United States Securities and Exchange Commission had awarded over $740 million to whistleblowers. By that same period, the Commodity Futures Trading Commission recovered nearly $1 billion for commodities-related fraud and paid whistleblowers more than $120 million.
Since 2007, the Internal Revenue Service’s Whistleblower Program has awarded whistleblowers more than $1 billion for helping the agency collect unpaid taxes. Whistleblower cases have led to the successful collection of $6.14 billion from non-compliant taxpayers.
Upcoding and unbundling are two methods of healthcare billing fraud that involve applying improper codes for different medical diagnoses and procedures. Healthcare providers that treat Medicare and Medicaid patients submit claims for reimbursement from the government using billing codes that identify what the patient received. When these healthcare providers knowingly improperly code what medical services were provided in order to obtain unwarranted funds from the government, they are committing coding fraud.
Each year, both the government and taxpayers whose money fund programs like Medicare and Medicaid lose billions of dollars to the healthcare fraud practices of upcoding and unbundling. If you have proof of coding fraud, contact the Medicare fraud qui tam lawyers of Tycko & Zavareei LLP today for a free legal consultation.