Sutter Health Medicare Advantage Fraud Case Shows the Power of Whistleblowers In August 2021, Sutter Health and several affiliated medical foundations agreed to pay $90 million to settle allegations that they submitted inaccurate diagnosis data to inflate payments under the Medicare Advantage program. The case is one of the largest Medicare Advantage fraud settlements on record, and it began with a single whistleblower, a former employee of the Palo Alto Medical Foundation who recognized what … [Read more...]
Pharmaceutical Fraud: Off Label Marketing, Kickbacks, and False Claims Act Liability
Pharmaceutical Fraud: Off Label Marketing, Kickbacks, and False Claims Act Liability Pharmaceutical companies have produced some of the largest False Claims Act settlements in history, and enforcement in this area continues at a significant pace. The conduct at the center of these cases follows patterns that have repeated across the industry for decades: drugs promoted for uses the FDA has not approved, kickback payments disguised as speaker fees or consulting arrangements, and prescriptions … [Read more...]
Hospital Billing Fraud: Common Red Flags for Whistleblowers
Hospital Billing Fraud: Common Red Flags for Whistleblowers Hospitals and health systems are among the most frequent targets of False Claims Act enforcement. The Department of Justice recovered over $5.7 billion in healthcare fraud settlements in fiscal year 2025 alone, the highest total ever recorded. A significant portion of that recovery came from cases involving hospitals, and many of those cases began with someone on the inside who noticed something wrong and came forward. If you work … [Read more...]
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Procurement Fraud Whistleblowers May Have Two Paths to Recovery The Department of Justice is sending a clear message to the market: if you have knowledge of anticompetitive conduct affecting federal procurement, the government wants to hear from you. A recent keynote address by Acting Deputy Assistant Attorney General Daniel Glad made plain that criminal antitrust enforcement is accelerating and that whistleblowers are now central to that effort. For individuals with knowledge of bid … [Read more...]
Why Whistleblowers Should Not Use AI to Draft Case Summaries
Why Whistleblowers Should Not Use AI to Draft Case Summaries If you believe your employer has been defrauding the federal government, your first instinct may be to organize your thoughts before contacting an attorney. Increasingly, potential clients are turning to AI tools like ChatGPT to help draft case summaries or intake narratives before reaching out to a law firm. While that impulse is understandable, using AI to build your case summary can create serious legal risks that may compromise … [Read more...]
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