Whistleblowers file many types of qui tam cases – ranging from healthcare fraud cases to defense fraud cases to other types of fraud – to expose and stop fraud that puts the health and wellbeing of patients, troops, workers, and others at risk, and that drains billions of dollars of taxpayer money from the US Treasury annually.
The False Claims Act is the government’s most effective tool for fighting fraud against the government. The law allows whistleblowers to file qui tam lawsuits against individuals and entities that are defrauding the government and to earn rewards if their cases are successful. More than $46.5 billion has been recovered as a result of qui tam lawsuits brought by whistleblowers.
If a whistleblower’s qui tam lawsuit is successful, the whistleblower can receive rewards of 15% to 30% of the funds recovered as a result of their case. The False Claims Act also offers whistleblowers protections against job retaliation they may experience for reporting fraud against the government.
Here are some common types of fraud that whistleblowers report by filing qui tam lawsuits.
Healthcare fraud typically involves false billing practices and corrupt relationships between physicians and hospitals, often at the expense of patients’ quality of care. Healthcare fraud saps limited medical resources and funds and can undermine patients’ treatment and wellbeing.
Healthcare fraud schemes can be complex and take on many forms. Healthcare whistleblowers working in hospital administration, healthcare IT, doctor’s offices, pharmaceutical companies, and health tech-related fields are some of those who have filed qui tam lawsuits.
They have reported fraud involving billing, kickbacks, illegitimate business relationships, off-label marketing, and more. Healthcare whistleblowers have filed qui tam lawsuits to protect patients’ health, public healthcare programs, and taxpayer funds.
As a result of qui tam cases that exposed healthcare fraud, the government has recovered more than 1.6 plus billions more in related criminal fines and state cases.
For specific types of healthcare fraud, see:
- Off-label marketing, kickbacks and other fraud by pharmaceutical companies
- Medical Devices and Implants
- Upcoding and Unbundling/Fragmentation
- False Certifications and Information
- Electronic Health Records (EHR) Fraud
- Lack of Medical Necessity
- Fraudulent Cost Reports
- Grant or Program Fraud
- Medicare Advantage Risk-Adjustment Fraud
- Medicare Part D Fraud
- Medical Loss Ratio Fraud
Defense contractor fraud
Fraud by defense contractors takes many forms – from skipping quality control for technologically complex military communications systems to cutting corners with logistics and supply deliveries to simply overbilling – but it all cheats taxpayers and can undercut national security.
The original False Claims Act was initially created during the Civil War to crack down on fraud by Union Army contractors. Defense contractor fraud also was the impetus in 1986 for the False Claims Act Amendments, which modernized and strengthened the law.
The government has collected more than $5.6B since 1986 due to qui tam cases that alleged defense fraud. For more information on defense contractor fraud, see:
- Product Substitution
- Violations of the Truth‑in‑Negotiations Act (TINA)
- Cross Charging
- Failure to Comply with Contract Specifications
- Contractor Fraud in Iraq and Afghanistan
- Improper Cost Allocation
Fraud in the Financial Industry
Fraud in the financial industry hurts economic growth, harms investors and can wreak havoc on markets. Most financial fraud cases fall under the Securities and Exchange Commission’s and the Commodity Futures Trading Commission’s purview, and therefore the SEC whistleblower program and the CFTC whistleblower program usually are the best places for whistleblowers to consider.
However, there are instances when the False Claims Act is applicable to financial fraud cases, such as:
Other Types of Fraud
The government spends money in many ways, so there are many ways the government can be defrauded. Whether it’s through cutting corners with shoddy concrete mixtures or poorly coded cyber security programs, scammers will try to cheat taxpayers whenever government money is on the line.
Unscrupulous fraudsters find ways to exploit disasters and crises, such as with FEMA funding for hurricane recovery or coronavirus pandemic relief funds.
- GSA Contracts
- Fraud in Construction Projects
- Failure to Meet Cybersecurity Standards in Government Contracts
- Customs Fraud