Claire M. Sylvia, a partner at Phillips & Cohen, is the author of a leading treatise on the False Claims Act and has represented whistleblowers in “qui tam” cases involving healthcare fraud, defense contractor fraud and cybersecurity issues.
Her book, The False Claims Act: Fraud Against the Government (with annual supplements), has served as an important reference for judges and attorneys in qui tam cases since it was first published.
She was recognized as a “Litigation Star” in California by Benchmark Litigation for her success in representing whistleblowers and for her expertise in False Claims Act matters.
Sylvia represented a whistleblower in a case against Humana Inc., which resulted in a $90 million settlement in 2024. This pathbreaking case alleged that Humana submitted fraudulent bids to the Centers for Medicare and Medicaid Services (CMS) to operate a Medicare Part D prescription drug plan.
Ms. Sylvia represented a whistleblower in a qui tam lawsuit against Cisco Systems that was one of the first successful False Claims Act cases — if not the first — involving cybersecurity issues. Cisco paid $8.6 million to the federal government and various states to settle the case, which alleged Cisco knowingly sold video surveillance systems used by federal and state agencies that had critical software flaws and could have been easily hacked.
Her other whistleblower cases include:
- A whistleblower lawsuit against UPMC and James Luketich MD settled for $8.5 million. The government intervened in the case, which alleged that UPMC had violated the False Claims Act by billing federal healthcare programs in violation of federal medical necessity and teaching physician requirements based on Dr. Luketich regularly performing as many as three complex surgical procedures at the same time. The government’s complaint alleged that this practice resulted in extended anesthesia time for patients and potential serious health consequences. As part of the resolution of the case, UPMC and Dr. Luketich also agreed to monitoring of billing practices by an independent auditor.
- A whistleblower case against Alliant Techsystems (ATK) that settled for about $37 million. The settlement included the cost to retrofit 76,000 defective military flares that put military personnel at serious risk of death or injury if the flares were accidentally dropped while being handled or in transit.
- A qui tam case against Adventist Health that settled for $14.1 million. The lawsuit alleged Adventist Health violated the False Claims Act based on the underlying violations of the Stark Statute and the Anti-Kickback Statute.
- A whistleblower lawsuit against Northrop Grumman, which alleged Northrop had failed to test certain electronic components it sold the U.S. military for use in the navigation systems of planes, helicopters and submarines. Northrop paid $12.5 million to settle the case.
- A whistleblower lawsuit against defense contractor AAR Corp. and a subsidiary that alleged that the aviation company did not adequately maintain aircraft used to transport troops in Afghanistan, raising safety concerns. AAR settled the case for $11 million and paid a $429,000 fine to the FAA.
- A qui tam case against Rocky Mountain Instrument Co. (RMI) that broke new ground in the application of the False Claims Act. It apparently was the first time the False Claims Act was used in connection with violations of International Traffic in Arms Regulations (ITAR) and the Arms Control Export Act.
Because of her expertise in the False Claims Act and qui tam cases, Ms. Sylvia has consulted with state officials on ways to create and effectively expand state whistleblower laws. She has provided testimony to Congress on Medicaid fraud enforcement and testified before the California Senate Judiciary Committee on the 2009 amendments to the California False Claims Act.
Ms. Sylvia has co-authored several articles on the False Claims Act and “Practitioner Insight” articles on the False Claims Act published on WestlawNext. She has been an invited speaker at numerous conferences on whistleblower laws and Medicare fraud.
Fighting fraud in government programs is a bipartisan issue.
Along with fellow Phillips & Cohen partner Erika A. Kelton, Ms. Sylvia regularly teaches a course on whistleblower law at Berkeley Law at the University of California. The class was one of the first courses on the False Claims Act and whistleblower laws taught at a major law school. They recently taught a similar course at the New York University School of Law.
Lawdragon recognized Ms. Sylvia’s work on behalf of whistleblowers by including her on its national list of the “500 Leading Plaintiff Financial Lawyers” for 2019, 2020, and 2023.
Ms. Sylvia joined Phillips & Cohen after 10 years with the San Francisco City Attorney’s Office, where she specialized in government ethics. Before working in the City Attorney’s Office, she was an assistant legal counsel in the Office of the U.S. Senate Legal Counsel. In that position, she represented Senate parties in litigation and advised Senate committees on legal matters related to investigations and other committee proceedings.
Ms. Sylvia graduated from Harvard Law School. She was a member of the Harvard Law Review. Following graduation, she clerked for the Honorable Mariana Pfaelzer, in the U.S. District Court for the Central District of California. Ms. Sylvia is admitted to the bar in California.
- “Humana to pay $90 million to settle fraudulent Medicare bid lawsuit,” Top Class Actions, August 22, 2024.
- “Attorneys: Humana settles whistleblower suit for $90M,” Fierce Healthcare, August 20, 2024.
- “Humana agrees to pay $90m to settle Medicare fraud case lawsuit in US,” World Pharmaceutical Frontiers, August 19, 2024.
- “Humana to pay $90 million to end 8-year Medicare Drug Battle,” Law 360, August 16, 2024.
- “Humana pays $90 million to federal government to settle whistleblower lawsuit,” Louisville Courier Journal, August 16, 2024.
- “Humana Will Pay $90 Million in Medicare Drug Fraud Settlement,” Bloomberg Law, August 16, 2024.
- “20 Years Ago, One Case Opened Up Billions In FCA Liability,” Law 360, May 8, 2024.
- “Justices Appear Open to Whistleblowers’ Drug Fraud Arguments, Bloomberg Law, April 18, 2023.
- “UPMC agrees to pay $8.5 million to settle whistleblower lawsuit filed by former surgeon,” WPXI, February 27, 2023.
- “Honeywell’s Damages Success May Be Hard for Others to Repeat,” Bloomberg Law, September 2, 2022.
- “IBM Must Face Suit Saying It Tricked IRS Into Software Deal,” Bloomberg Law, July 6, 2021.
- “COVID-19 Revenue Hit May Bode Well For Calif. FCA Tax Law,” Law360, June 16, 2020.
- “Saving Stark,” Proto Magazine, October 7, 2019.
- “For $8.6M, Cisco Settles Suit Over Bug-Riddled Video Surveillance Software,” Threatpost, August 1, 2019.
- “Cisco Pays $8.6m to Settle Software Flaw Claims,” InfoSecurity Magazine, August 1, 2019.
- “Cisco fined for selling software with security flaws,” TechRadar, August 1, 2019.
- “Cisco Settles Whistleblower Suit Over Alleged Security Flaws for $8.6M,” Corporate Counsel by Law.com, July 31, 2019
- “Circuit Splits Over Fraud Law Endure as Top Court Ruling Turns 3,” Bloomberg Law, June 14, 2019.
- “How Supreme Court Conservatives Have Shaped the FCA,” Law360, May 17, 2019.
- “Needed or outdated? Trump officials and Congress eye healthcare fraud and abuse rules,” The Washington Examiner, September 18, 2018.
- “More Relators Push FCA Cases To The End In 2017,” Law360, January 4, 2018.
- “Supreme Court to decide who is a protected whistleblower in corporate America,” LA Times, November 28, 2017.
- “Dueling Counsel Views on Off-label Marketing Ruling,” Bloomberg BNA, November 1, 2017.
- “$663M Reversal Has Silver Lining For Whistle-Blowers, Attorneys Say,” Bloomberg Government Federal Contracts Report, October 10, 2017.
- “University, Testing Lab Win Fraud Case on Transplant Allegations,” Bloomberg BNA Health Care Fraud Report, July 7, 2017.
- “Don’t Mistake Payments For Approval, U.S. Attorneys Say,” Bloomberg BNA, (Reproduced with permission from Federal Contracts Report 107 FCR 5/30/17. Copyright 2017 by The Bureau of National Affairs, Inc. (800-372-1033) <http://www.bna.com>).
- “Intervention in False Claims Act Lawsuits: Is It Make or Break?” Bloomberg BNA, April 24, 2017.
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“Little-noticed interim rule overshadows two Supreme Court procurement decisions,” Federal News Radio, Jun 20, 2016.
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“Health First calls for dismissal of over USD 1bn in whistleblower case, arguing allegations are already public,” DebtWire.
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“How do you make millions by doing good? Become a whistleblower,” The Guardian, May 14, 2015.
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“FCA Wave Sparks Debate Over DOJ Power To Boot Weak Suits,” Law360, May 2, 2014.
- “Getting On With It: Proceeding with Discovery in False Claims Act Qui Tam Cases While a Motion to Dismiss is Pending,” Turning Square Corners, Federal Bar Association newsletter, Summer 2024.
- “FCA Whistleblower Retaliation Ruling Raises Stakes for Employers,” Bloomberg Law.
- “The Evolving Debate Over The Government’s Dismissal Authority Under The False Claims Act,” The Government Contractor.
- “Ruling cools overheated debate about dismissing FCA cases,” The Daily Journal.
- “Why the Security Industry Should Pay Attention to the Cisco Whistleblower Case” – Infosecurity Magazine.
- “The False Claims Act: Fraud Against the Government,” 4th edition – Thomson Reuters.
- “Supreme Court Says No Free Pass for Qui Tam Defendants in False Claims Act Cases” – Law.com.
- “FCA 2023 Year in Review” – Federal Bar Association, February 22, 2024
- “(c)(2)(A) Dismissals After Polansky” – Federal Bar Association, Dec. 13, 2023
- “Constitutionality of the Qui Tam Provisions” – The Anti-Fraud Coalition 23rd Annual Conference, October 19, 2023
- “Year in Review” – Federal Bar Association’s 2022 Qui Tam Conference, Feb. 16, 2023
- “SCOTUS Watch: The Latest in the Debate Over DOJ’s Dismissal Authority and the Requisite Pleading Standard for False Claims Act Qui Tam Claims” — ACI’s False Claims & Qui Tam Enforcement Conference, Jan. 23, 2023
- “Hot Topics & Trends” – Taxpayers Against Fraud Education Fund Annual Conference, October 26, 2022
- “Year in Review” – Federal Bar Association’s 2022 Qui Tam Conference, Feb. 23, 2022
- Speaking Up: Whistleblowers, Whistleblowing and the US’s Unique Approach to Fraud Enforcement Part 2 – Berkeley Boosts, April 22, 2021
- “Year in Review” – Federal Bar Association’s 2021 [Virtual] Qui Tam Conference, February 2021
- “Recent case law involving materiality” – Taxpayers Against Fraud Education Fund Virtual Conference, October 2020
- “Year in Review” – Federal Bar Association’s 2020 Qui Tam Conference, February 2020
- “False Claims Act Developments” – ABA’s 29th Annual National Institute on Health Care Fraud – May 2019
- A Year in Review – Federal Bar Association 2019 Qui Tam Conference – February 28, 2019
- “Developments in FCA liability” – Taxpayers Against Fraud Education Fund Annual Conference – Washington, DC, October 2018
- Hearing on Modernizing Stark Law to Ensure the Successful Transition from Volume to Value in the Medicare Program – House Ways and Means Health Subcommittee hearing – July 17, 2018 [Read Ms. Sylvia’s testimony.]
- “The Relator’s Perspective” – ABA 12th National Institute on the Civil False Claims Act and Qui Tam Enforcement – June 13, 2018
- “Criminal, Civil, and Administrative Enforcement in Kickback Cases” – 28th Annual National Institute on Health Care Fraud – May 3, 2018
- The Aftermath of the Supreme Court’s Decision on the So-Called “Implied Certification” Case – NHCAA Annual Training Conference – November 17, 2016
- Damages & Penalties: Calculation Challenges in Healthcare Fraud – CLE 3rd Annual conference on Qui Tam: A Close Look at Healthcare Fraud and More
- Taxpayers Against Fraud Annual Conference Panels including: FCA 101; The FCA Amendments Five Years Later; Preparing Your Qui Tam Case; The New Public Disclosure Bar; Avoiding the False Certification Trap – 2006-2016
- Is government Adequately Protecting Taxpayers from Medicaid Fraud? – Congressional Oversight Committee Joint Hearing – April 25, 2012
- Damages and Penalties – What Gets Trebled and How Many Penalties? – CLE Qui Tam/False Claims Act: Practitioner Perspectives
Watch Ms. Sylvia’s testify about the importance of the Stark Law to protect patients and taxpayer dollars at a House subcommittee hearing below.
- “500 Leading Plaintiff Financial Lawyers” – Lawdragon, 2019-2024
- Northern California Super Lawyers list – Super Lawyers, 2020, 2021, 2022, 2023
- Litigation Star – Benchmark Litigation, 2019 – 2024
- Best Lawyers in America” – Best Lawyers, 2023, 2024