Illegal kickback arrangements corrupt medical decision-making, drive up costs for federal healthcare programs, and expose patients to unnecessary services. If you work in healthcare and have witnessed payments or benefits being exchanged for referrals to Medicare or Medicaid providers, you may have the basis for a qui tam case. Reach out for a confidential conversation. There is no obligation.
Illegal kickback arrangements corrupt medical decision-making, drive up costs for federal healthcare programs, and expose patients to unnecessary services. If you work in healthcare and have witnessed payments or benefits being exchanged for referrals to Medicare or Medicaid providers, you may have the basis for a qui tam case. Reach out for a confidential conversation. There is no obligation.
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A healthcare kickback is any payment, benefit, or other remuneration offered, paid, solicited, or received in exchange for referring patients to a healthcare provider, facility, or service that is reimbursed by Medicare, Medicaid, or another federal healthcare program. Kickback arrangements are illegal regardless of how they are structured or what label is used to describe the payment.
The Anti-Kickback Statute makes it a federal crime to knowingly and willfully offer, pay, solicit, or receive remuneration to induce or reward referrals of items or services covered by federal healthcare programs. Because kickback-tainted claims submitted to Medicare or Medicaid are ineligible for payment, they also constitute false claims under the False Claims Act. Healthcare insiders who have direct, first-hand knowledge of kickback arrangements may be eligible to file a qui tam lawsuit on behalf of the government and receive a share of any financial recovery.
Gilead Sciences, Inc. agreed to pay $176 million for offering and paying kickbacks in fiscal year 2025, one of the largest Anti-Kickback Statute settlements in that year’s DOJ enforcement record.
Source: U.S. Department of Justice, FCA Fact Sheet FY 2025, January 2026 | justice.gov
Legal basis: 42 U.S.C. § 1320a-7b (Anti-Kickback Statute) | 42 U.S.C. § 1395nn (Stark Law) | 31 U.S.C. § 3729 (False Claims Act) | Source: uscode.house.gov
Kickback schemes vary widely in how they are structured. The following are the most common types handled by this practice.
Anti-Kickback Statute Violations: The Anti-Kickback Statute prohibits any remuneration intended to induce or reward referrals of Medicare or Medicaid business. This includes cash payments, free services, inflated consulting fees, below-market office space or equipment, and any other benefit offered in exchange for patient referrals. Both the party paying the kickback and the party receiving it can be held liable under the statute.
Illegal Referral and Marketing Arrangements: Some kickback schemes involve arrangements in which sales representatives, marketers, or other third parties are compensated on the basis of the volume or value of referrals they generate, rather than for legitimate services rendered. These arrangements violate the Anti-Kickback Statute when the referrals are for items or services covered by federal healthcare programs.
Physician Compensation Schemes: Kickbacks to physicians are frequently disguised as consulting fees, medical directorship payments, speaking honoraria, or research grants. When these payments are offered or accepted in exchange for referrals, rather than for genuine services, they violate the Anti-Kickback Statute and render any resulting claims to Medicare or Medicaid false.
Stark Law (Physician Self-Referral Law) Violations: The Stark Law prohibits physicians from referring patients for certain designated health services, including home health, laboratory, and imaging services, to entities with which the physician has a financial relationship, unless a specific exception applies. Unlike the Anti-Kickback Statute, the Stark Law is a strict liability statute and does not require proof of intent. Claims submitted in violation of the Stark Law may also violate the False Claims Act.
Legal basis: 42 U.S.C. § 1320a-7b (Anti-Kickback Statute) | 42 U.S.C. § 1395nn (Stark Law) | Source: uscode.house.gov
Kickback arrangements are rarely described as such. Healthcare organizations and individuals who pay or receive kickbacks typically use legitimate-sounding labels to disguise the payments. Common methods of concealment include consulting agreements that involve little or no actual consulting work, medical directorship fees paid in excess of the fair market value of services actually provided, management service organization (MSO) investment returns paid to physicians based on the volume of their referrals rather than the performance of their investment, marketing commissions based on the volume or value of referrals generated, and free or below-market goods or services provided to referring providers.
Employees who work inside these arrangements, including billing staff, compliance officers, administrative personnel, and clinical employees, often recognize the discrepancy between how payments are described and what they are actually for. If you have witnessed conduct that you believe involves payments made in exchange for referrals, that is enough to start a confidential conversation.
The strongest kickback qui tam cases come from current or former employees with direct, first-hand knowledge of the arrangement from inside the organization. This includes billing specialists and compliance officers who see the invoices or contracts, clinical staff who observe referral patterns driven by financial relationships, administrative employees with access to vendor contracts or physician compensation agreements, sales and marketing staff who are involved in structuring or executing referral arrangements, and laboratory, pharmacy, or device company employees who are aware of payments made to referring providers.
You do not need documents or conclusive proof before reaching out. If you have credible, first-hand knowledge of what you believe is an illegal kickback arrangement involving a federal healthcare program, that is enough to start a confidential conversation. We investigate thoroughly before asking for any commitment.
In fact, many former employees come forward with knowledge of fraudulent practices by their former employers after they have been demoted or terminated for complaining to their supervisors about the fraudulent practices or leaving their employment because they refuse to participate in the fraud.
Legal basis: 31 U.S.C. § 3730(b) (qui tam provisions) | Source: uscode.house.gov
The False Claims Act prohibits your employer from firing, demoting, suspending, harassing, or otherwise retaliating against you for reporting fraud or participating in a qui tam case. These anti-retaliation protections apply to both current and former employees.
When you file a qui tam complaint, it is submitted under seal and served on the Department of Justice and any state agencies that have been impacted by the alleged fraud. Your employer is not notified and does not receive a copy of the complaint. Your identity remains protected throughout the government’s investigation.
If your employer retaliates against you, you have legal remedies that include reinstatement, two times the amount of back pay owed, interest on that back pay, and compensation for special damages including litigation costs and attorney fees.
Legal basis: 31 U.S.C. § 3730(h) (anti-retaliation) | 31 U.S.C. § 3730(b) (under seal filing) | Source: uscode.house.gov
When a qui tam lawsuit results in a financial recovery, the False Claims Act entitles the relator to receive a percentage of the total amount recovered by the government. If the government intervenes and takes over the case, the relator may receive between 15% and 25% of the recovery. If the government declines to intervene and the relator proceeds independently, the share can rise to between 25% and 30%. There is no cap on the dollar amount of the reward. We work on a contingency fee basis. There is no upfront cost, and if there is no recovery, you owe us nothing.
Legal basis: 31 U.S.C. § 3730(d)(1) and § 3730(d)(2) | Source: uscode.house.gov
Arvind Bob Khurana has over 27 years of experience in qui tam and False Claims Act litigation, complex commercial litigation, and class action matters. He began his career at a top international defense firm and joined a national class action firm in 2005, becoming partner in 2009, where he worked on ERISA actions, qui tam cases, securities fraud, and antitrust matters. He is admitted to the New York State Bar and represents whistleblowers in federal courts nationwide.
We are selective. Before we ask for any commitment, we investigate the claim, explain the facts and the risks, and give you a complete picture of what you are facing. We never ask you to sign a retainer agreement until you have the full picture and have decided, on your own terms, that you want to move forward. You remain in control throughout.
Arvind Bob Khurana has over 27 years of experience in complex litigation. We work on contingency. There is no upfront cost and no obligation to proceed.
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