If you work in healthcare and have witnessed Medicare or Medicaid fraud, you likely have questions and serious concerns. You are not alone, and you have more protection than you may realize. These answers are here to help you understand your rights, your options, and what it looks like to work with us. If you don’t see your question here, reach out for a confidential conversation. There is no obligation.
If you work in healthcare and have witnessed Medicare or Medicaid fraud, you likely have questions and serious concerns. You are not alone, and you have more protection than you may realize. These answers are here to help you understand your rights, your options, and what it looks like to work with us. If you don’t see your question here, reach out for a confidential conversation. There is no obligation.
People like you, who work inside organizations and have seen what others cannot see from the outside, are the foundation of a successful whistleblower case. Speaking with an attorney first, before taking any other action, is the most important thing you can do right now.
The strongest cases come from people with direct, first-hand knowledge of fraud from inside a healthcare organization. This includes current or former:
If you have witnessed fraudulent billing, upcoding, kickbacks, falsified records, or other schemes within your organization, you may have a valid qui tam claim. We only take cases we believe are viable, and we will tell you honestly whether yours qualifies.
We represent current or former employees of healthcare organizations who have direct, inside knowledge of Medicare or Medicaid fraud. Members of the public reporting suspicions about someone they know that might be improperly receiving government benefits are difficult to prove and generally not the type of matters we take on.
If you have a tip about potential Medicare fraud but are not an insider, the right channel is the HHS Office of Inspector General at oig.hhs.gov or by calling 1-800-HHS-TIPS.
A qui tam case requires significant resources for the investigation, preparation of the complaint, document review, and litigation. If the government’s loss is under $1 million, the legal fees and DOJ resources often outweigh the potential recovery. However, many times, the relator is not aware of the gravity of the fraud and what a relator believes may be a smaller fraud, can actually be part of a larger scheme where the damages are in the millions of dollars. It is best to start a private confidential conversation with us about what you have witnessed and whether you have a case.
Generally, no. This practice typically represents current or former employees of healthcare organizations, not Medicare or Medicaid patients or beneficiaries. If you are a Medicare or Medicaid patient with concerns about your own care or billing, we encourage you to contact the HHS Office of Inspector General at oig.hhs.gov.
No. This practice is focused exclusively on Medicare or Medicaid fraud and federal whistleblower cases under the False Claims Act. We do not handle personal injury matters or private insurance fraud cases.
No. Attorney-client privilege applies from the moment you reach out. Nothing you share is disclosed to anyone, not your employer, not the government, not anyone, without your knowledge and consent.
You can speak freely. Reaching out to us does not trigger any investigation, alert your employer, or set anything in motion. It simply starts a private confidential conversation about what you have witnessed and whether you have a case.
Yes. Whistleblower complaints under the False Claims Act are filed under seal. This means your identity and the details of your complaint remain confidential during the government’s investigation. Your employer is not notified.
We take specific steps from the very beginning to protect your identity and preserve your legal protections throughout the process. Your anonymity is not a side consideration. It is a priority we plan for from day one.
That said, if a case eventually proceeds to trial, confidentiality may become more limited. An experienced attorney will help you understand exactly what to expect at each stage, so you are never surprised.
Legal basis: 31 U.S.C. § 3730(b) (under seal provision)
In most cases, your employer will not be aware during the initial investigation period. The complaint is filed under seal, and the government investigates without disclosing your identity.
If the case moves forward, the seal will eventually be lifted, and by that point, your legal protections are firmly in place. We manage the timing carefully and keep you informed at every step so you always know where things stand.
The law specifically prohibits your employer from firing, demoting, suspending, harassing, or discriminating against you because you reported fraud or participated in a qui tam case.
Legal basis: 31 U.S.C. § 3730(h)
The single best step you can take right now is to speak with a whistleblower attorney, in complete confidence, before doing anything else. Reporting the fraud internally may result in retaliation by your employer, including your termination. We will assess your situation, explain your options, and tell you exactly what to do next. You remain in control throughout.
Yes. A non-disclosure agreement cannot lawfully prevent you from reporting fraud to the federal government or filing a qui tam lawsuit under the False Claims Act.
Many healthcare employees sign confidentiality agreements or NDAs as part of their employment. These agreements are enforceable in many contexts, but they cannot be used to block a whistleblower from coming forward about Medicare or Medicaid fraud. Federal law explicitly protects your right to report Medicare and Medicaid fraud to the government, and any contractual clause that attempts to prevent this is unenforceable against a qui tam relator.
If you are concerned that an NDA you signed may affect your ability to come forward, speak with an attorney. In most cases, it will not be an obstacle. Do not let an NDA be the reason you stay silent.
Legal basis: 31 U.S.C. § 3730(h)
The False Claims Act is the federal law that makes it illegal to submit false or fraudulent claims for payment from the U.S. government, including Medicare. It is also the law that allows insiders like you to come forward, file a lawsuit on behalf of the government, and share in any recovery.
In fiscal year 2025, the Department of Justice recovered over $6.8 billion through False Claims Act settlements and judgments, the highest single-year total in the history of the False Claims Act. Of that total, over $5.7 billion involved the healthcare industry.
Source: U.S. Department of Justice, FCA Statistics FY 2025 (January 2026) | Legal basis: 31 U.S.C. § 3729
A qui tam lawsuit is filed by a private individual, called a relator, on behalf of the federal government under the False Claims Act. You bring the evidence. The government investigates. If there is a recovery, you receive a share of it.
The term comes from Latin: “he who sues on behalf of the king as well as for himself.” The case is filed under seal, meaning it is not public. Your employer does not know. The process begins quietly and confidentially.
Legal basis: 31 U.S.C. § 3730(b) and § 3730(d)
We represent employees and insiders in cases involving complex healthcare fraud against the federal government. This includes:
Legal basis: 42 U.S.C. § 1320a-7b (Anti-Kickback Statute) | 42 U.S.C. § 1395nn (Stark Law)
Upcoding occurs when a healthcare provider bills Medicare for a more expensive service, diagnosis, or procedure than was actually provided or supported by the patient’s medical records. For example, billing for a complex hospital visit when a routine check-up occurred, or submitting a more serious diagnosis code to receive a higher Medicare payment.
In Medicare Advantage plans, upcoding often involves exaggerating a patient’s diagnoses to inflate risk adjustment scores, which increases what Medicare pays the insurer per member. If you have observed a pattern of upcoding at your organization involving Medicare or Medicaid billing, this may form the basis of a qui tam claim.
Source: HHS-OIG Work Plan | Legal basis: 42 U.S.C. § 1320a-7b
No. You do not need documents, records, or conclusive evidence before speaking with us. If you have credible knowledge of what you believe is fraud, that is enough to start a conversation. However, if you have documents such as medical records, internal reports or emails, then those documents may be strong evidence that the government can use for its investigation.
In fact, reaching out early, before you gather documents on your own, is often the right move. We can advise you on what evidence matters, how to preserve it, and how to do so without putting yourself at unnecessary risk. Every step is guided and protected.
Out of concern for violating HIPAA, a whistleblower may be hesitant to disclose fraud to qui tam attorneys or to the federal government. Fortunately, HIPAA authorizes whistleblowers to disclose such confidential information when filing qui tam lawsuits, if the whistleblower believes in good faith that the defendant has engaged in conduct that is unlawful.
Source: 45 CFR § 164.502(j)(1)
The strongest cases involve: first-hand knowledge of fraud from within a healthcare organization, fraudulent billing connected to Medicare or federal programs, and conduct that caused actual financial harm to the government.
We investigate thoroughly before we take a case. We never waste your time. We never ask you to sign a retainer agreement until we have properly reviewed the facts, explained the merits, and discussed the potential benefits and the real risks. You decide whether to move forward. Always. We will never pressure you into moving forward. We want you do be comfortable doing so.
Once a qui tam complaint is filed, it is submitted under seal to the federal government. The Department of Justice and agencies such as the HHS Office of Inspector General as well as state Medicaid fraud units conduct a private investigation to evaluate the evidence.
The government then decides whether to intervene and pursue the case alongside you, or to decline, in which case you may still proceed independently. Throughout the investigation, we work closely with government attorneys, keep you informed, and protect your interests at every stage.
You will not be left alone in this process. We are with you from the first conversation to the final resolution.
These cases take time, often between one and several years, depending on the complexity of the fraud and the scope of the government’s investigation. The investigation phase alone can take a year or more before any formal action is taken.
What matters most is that you act before the statute of limitations runs. The False Claims Act has time limits that can bar a claim if too much time passes. Starting early, with proper legal guidance, is critical.
Legal basis (statute of limitations): 31 U.S.C. § 3731(b)
The clock is running from the day the fraud occurred. Do not wait.
Under the False Claims Act, a qui tam complaint must be filed within six years of the date the fraud occurred. There is a secondary rule that allows filing within three years of when the government knew or should have known about the fraud, but no case can be filed more than ten years after the violation. In practical terms, the six-year rule is the one that matters for most cases.
If you are aware of fraud that occurred several years ago, the time to act is now. An experienced attorney can assess whether your case is still within the filing window and take immediate steps to protect your claim.
Legal basis: 31 U.S.C. § 3731(b)
The False Claims Act has a first-to-file rule. Only the first person to file a qui tam lawsuit based on a specific set of facts can receive the whistleblower reward for that case. If another relator has already filed a complaint covering the same underlying fraud, a later complaint on the same facts will be dismissed.
This is one of the strongest reasons not to delay. If you have knowledge of fraud, speak with an attorney immediately to assess whether a case has already been filed and to protect your position.
Legal basis: 31 U.S.C. § 3730(b)(5)
When a qui tam complaint is filed, the whistleblower must also submit a confidential disclosure statement directly to the Department of Justice. This is a separate document from the court complaint. It provides the government with a detailed explanation of the alleged fraud, the supporting evidence, and identifies key witnesses and documents.
The disclosure statement is one of the most important documents in a whistleblower case. The government uses it to decide whether to open a full investigation and whether to intervene. A well-prepared, precisely written disclosure significantly improves the likelihood that the DOJ views the case as credible and worthy of intervention. This is one of the clearest ways in which having an experienced attorney from the start makes a direct difference in the outcome.
Filing under seal means the complaint is kept secret from your employer and the public while the government investigates. This is the legal mechanism that protects your identity.
When a qui tam complaint is filed, it is submitted to the court and to the Department of Justice, but placed under seal. Your employer does not receive a copy. The case does not appear in public court records during this period. The government investigates privately, and the initial seal period is sixty days, though courts routinely grant extensions. Complex cases often remain sealed for a year or longer.
The seal is eventually lifted when the government decides whether to intervene. At that point, the complaint becomes public. By then, your legal protections are firmly in place and your attorney will have managed the timing carefully.
Legal basis: 31 U.S.C. § 3730(b)
They refer to the same person. A whistleblower is the common term for someone who comes forward to expose fraud or misconduct. A relator is the legal term used in the False Claims Act for the private individual who files a qui tam lawsuit on behalf of the federal government.
If you file a qui tam complaint, you are both a whistleblower and a relator. The term relator appears in the statute and in court filings. Your attorney will use both terms depending on context, but they always refer to you.
Legal basis: 31 U.S.C. § 3730(b)
Medicare Advantage, also known as Medicare Part C, is a privately administered version of Medicare. Because the government pays insurers a fixed amount per member based on how sick their patient population is, plans have a financial incentive to make patients appear sicker than they are. This creates significant opportunity for fraud.
Common Medicare Advantage fraud schemes include upcoding diagnoses to inflate risk adjustment scores, chart mining (using automated tools to surface diagnoses that are not supported by clinical records), sham RADV audit preparations, and incentivizing physicians to add unsupported diagnosis codes. These schemes result in the government overpaying insurers by billions of dollars each year.
In January 2026, the Department of Justice announced that five Kaiser Permanente affiliates agreed to pay $556 million to resolve False Claims Act allegations involving unsupported diagnosis codes in their Medicare Advantage program, the largest Medicare Advantage fraud settlement in history. If you work inside a Medicare Advantage plan and have witnessed these practices, you may have the basis for a significant qui tam case.
Source: U.S. Department of Justice, January 2026 | Legal basis: 31 U.S.C. § 3729
As artificial intelligence tools have become common in healthcare operations, some organizations have begun using them to commit fraud. AI-assisted Medicare fraud typically involves using algorithms or data mining tools to identify and add unsupported diagnosis codes to patient records, which inflates the payments the organization receives from Medicare.
The Kaiser Permanente case, settled in January 2026 for $556 million, centered on the use of data mining tools to surface diagnoses that were never clinically established. The DOJ has identified this type of fraud as one of its top enforcement priorities as these technologies become more widespread across the healthcare industry.
Using AI or automated tools to manipulate billing carries the same False Claims Act exposure as any other form of Medicare fraud. If your employer is using technology to add unsupported diagnoses or inflate risk scores, you may have grounds for a qui tam case.
Telemedicine fraud involves billing Medicare for remote services that were not actually provided, or using telemedicine or telehealth arrangements to generate illegal kickbacks. Common schemes include billing for virtual visits that never occurred, ordering unnecessary tests or durable medical equipment for patients seen via telemedicine, and paying or receiving fees for patient referrals through telemedicine or telehealth platforms in violation of the Anti-Kickback Statute.
Telehealth fraud was a primary focus of the 2025 National Health Care Fraud Takedown, in which the Department of Justice charged 324 defendants in schemes involving over $14.6 billion in alleged fraud. The DOJ has made telehealth enforcement a sustained priority.
If you work for a telemedicine company or a healthcare organization that uses telehealth and have witnessed fraudulent billing practices, you may have a viable qui tam case.
Yes. You do not need to be currently employed to file a qui tam case. Former employees file successful whistleblower cases regularly.
The False Claims Act does not require you to be a current employee of the organization you are reporting. If you witnessed Medicare or Medicaid fraud during your employment and have since left the organization, you may still have a valid claim, provided you are within the statute of limitations.
Anti-retaliation protections also extend to former employees. If you were terminated or pushed out in connection with your knowledge of fraud, or because you raised concerns internally, you may have a retaliation claim in addition to a qui tam case.
Legal basis: 31 U.S.C. § 3730(h)
Yes. Under the False Claims Act, whistleblowers who bring successful qui tam cases are entitled to receive a percentage of the government’s recovery. In fiscal year 2023, the Department of Justice paid out over $349 million to individuals who came forward to expose fraud.
These rewards reflect the government’s recognition that insiders take real risks and deserve real compensation for their courage.
Source: U.S. Department of Justice, FCA Statistics FY 2023 | Legal basis: 31 U.S.C. § 3730(d)
The percentage depends on the government’s level of involvement:
There is no cap on the dollar amount. The exact percentage within these ranges depends on factors such as your contribution to the case and whether you had any role in the underlying conduct.
Legal basis: 31 U.S.C. § 3730(d)(1) and § 3730(d)(2)
Nothing upfront. We do not bill you by the hour. We work on contingency. You pay nothing unless there is a recovery. If there is no recovery, you owe us nothing.
We only take on cases we believe are viable. If we do not think you have a case, we will tell you honestly and without pressure. We will never ask you to sign a retainer agreement until we have properly investigated and you have decided, on your own terms, that you want to move forward.
It is not over. You can still pursue the case independently, and declined cases have resulted in billions of dollars in recoveries for whistleblowers.
When the government declines to intervene, it means the DOJ has decided not to take over the case at that time. The whistleblower may still proceed with the lawsuit independently. If the case is successful without government intervention, the relator receives a higher share of the recovery, between 25% and 30% of the proceeds, compared to 15% to 25% when the government is involved.
Declined cases are not lost cases. Since 1986, whistleblowers who proceeded independently after government declinations have recovered billions of dollars. We routinely proceed with cases after declination and have recovered millions of dollars. An experienced attorney can assess whether your case has sufficient merit to pursue independently and guide you through that decision.
Legal basis: 31 U.S.C. § 3730(d)(2) | Source: U.S. Department of Justice, FCA Statistics FY 2025
Medicare and Medicaid fraud carries serious civil and criminal penalties for the organizations and individuals who commit it. Under the False Claims Act, civil penalties include repayment of three times the amount fraudulently obtained from the government, plus a fine of between $14,308 and $28,619 per false claim submitted. A single fraudulent billing practice affecting thousands of claims can result in penalties in the tens or hundreds of millions of dollars.
In addition to civil penalties, Medicare fraud can result in criminal prosecution under federal healthcare fraud statutes, with potential imprisonment of up to ten years per offense, and permanent exclusion from participation in Medicare, Medicaid, and all federal healthcare programs. For healthcare providers, exclusion is often a career-ending outcome.
These penalties reflect why the government relies so heavily on whistleblowers. The scale of fraud is too large for routine audits to catch, and the insider knowledge you possess is often the only way these schemes are ever discovered.
Legal basis: 31 U.S.C. § 3729(a)(1) | Penalty amounts: 28 CFR § 85.5 (effective July 3, 2025)
Arvind Bob Khurana is the founder and principal attorney at Khurana Law Firm, P.C. He has over 25 years of experience in qui tam and whistleblower litigation, complex commercial litigation, and class action lawsuits, including Medicare and Medicaid fraud cases under the False Claims Act.
He began his career in the litigation group of a top international defense firm representing Fortune 500 clients. In 2005, he joined a national class action firm, becoming a partner in 2009, where he worked on ERISA actions, qui tam cases, securities fraud, and antitrust matters. He has been representing whistleblowers nationwide ever since.
He is admitted to the New York State Bar and numerous federal courts and represents clients across the United States.
Yes. Khurana Law Firm represents whistleblowers nationwide. Medicare and Medicaid fraud cases are federal matters filed in federal court under the False Claims Act regardless of where the fraud occurred. Your location does not limit your ability to work with us.
We are selective. Many firms take on as many cases as possible, including cases with a marginal chance of success, and ask you to sign a retainer before they have investigated anything.
We do the opposite. Before we ask for any commitment from you, we thoroughly investigate your claim, explain the facts and the risks, and give you a complete picture of what you are facing. We honor the courage it takes to come forward. We never take that for granted, and we never waste your time.
Medicare Whistleblower Center is the dedicated federal healthcare fraud and whistleblower practice within Khurana Law Firm, P.C. It focuses exclusively on representing insiders who pursue qui tam claims under the False Claims Act. Khurana Law Firm, P.C. is based in New York at 16 Madison Square West, 11th Fl., New York, NY 10010.
Choosing the right attorney is one of the most important decisions you will make in this process. The quality of the disclosure statement, the strategy for presenting the case to the DOJ, and the ability to navigate parallel investigations all depend heavily on counsel with direct False Claims Act experience.
When evaluating attorneys, look for: specific experience in qui tam and False Claims Act cases, not just general healthcare or litigation work; a contingency fee structure with no upfront costs; a willingness to thoroughly investigate the facts before asking you to sign a retainer agreement; and an attorney who treats your decision with the seriousness it deserves rather than pressuring you to move quickly.
At Khurana Law Firm, we investigate thoroughly before asking for any commitment. We explain the facts, the potential benefits, and the real risks. We never ask you to sign a retainer until you have the full picture and are confident in your decision. You remain in control throughout.
No obligation. 100% confidential.
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