Whistleblowers Amplify False Claims Act Healthcare Fraud Enforcement

September 23, 2026

Whistleblowers Amplify False Claims Act Healthcare Fraud Enforcement

For more than 150 years, the False Claims Act has been one of the federal government’s most powerful tools for combating fraud against taxpayer-funded programs, and whistleblowers have been key to its success.

What Is the History of the False Claims Act?

The False Claims Act (FCA), which imposes penalties on anyone who knowingly submits false or fraudulent claims to the federal government, was passed following the Civil War after defense contractors were found to have knowingly sold the government unfit horses, spoiled food and faulty weapons.

Importantly, the False Claims Act allows private citizen whistleblowers to file what are called “qui tam” lawsuits on behalf of the government to combat fraud. Based on inside knowledge of fraudulent activity observed by the whistleblowers, these lawsuits often lead to investigations by the government, as they assess whether fraud occurred and the damages caused. Whistleblowers are allowed by law to receive up to 30 percent of the financial recovery. Qui tam filings in 2025 numbered 1,297, breaking the previous record of 979 set in 2024.

Healthcare-related fraud is now the largest category of False Claims Act enforcement. In 2025, settlements and judgments under the False Claims Act totaled $6.8 billion. A staggering $5.7 billion of that total was from health care–related cases.

What Counts As a Healthcare Fraud Case Under the False Claims Act?

Healthcare-related fraud takes many forms and often involves taxpayer-funded programs like Medicare, Medicaid and TRICARE, the healthcare program for members of the military and their families. Violations occur when a healthcare provider or organization knowingly submits or causes the submission of false claims so they can receive government payments. This includes filing claims for services not provided, charging for medically unnecessary procedures, inflating claims pricing, paying illegal kickbacks, and falsifying records or diagnoses.

Waters Kraus Paul & Siegel attorneys have been on the front lines of this evolving area of litigation. Their work has resulted in impactful settlements, including:

What is the Penalty for Violating the False Claims Act?

Stiff financial penalties are one of the reasons the False Claims Act is an effective fraud enforcement tool. By law, defendants can be required to pay three times the amount of the government’s losses (also called treble damages) plus civil penalties for each false claim submitted.

Why Experience Matters in Qui Tam Litigation

Coming forward as a whistleblower involves strict procedural rules and significant personal and professional risk. Working with an experienced firm early can make a meaningful difference in both the strength of the case and your protection throughout it.

  • Navigating complex filing requirements
    False Claims Act cases must be filed under seal and comply with detailed federal procedures. Missteps at the outset can jeopardize the claim or your eligibility for a recovery.
  • Protecting against retaliation
    Counsel can advise on how to report concerns while minimizing employment risk and preserving your rights if retaliation occurs.
  • Maximizing potential recovery
    Whistleblower awards depend in part on the quality and impact of the case. Experienced firms understand how to develop claims that lead to meaningful enforcement outcomes.

Early guidance from a firm with deep False Claims Act experience helps ensure that your actions are protected, claims are viable, and contributions are taken seriously by the government.

Our Results

$880 million award

Historic settlement for over 1,300 survivors of clergy and adult abuse within the Roman Catholic Archdiocese of Los Angeles, marking a pivotal moment for justice.

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$725.5 million award

A Philadelphia jury awarded a record verdict against ExxonMobil for failing to warn about cancer risks due to benzene in its petroleum products.

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$25 million award

Private equity firm and co-defendants agree to pay $25M in Medicaid fraud case alleging mental health services provided by unqualified providers.

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