The Department of Justice announced extraordinary results for fiscal year 2025, with False Claims Act (FCA) settlements and judgments exceeding $6.8 billion—the highest amount recovered in a single year in the statute's history. The FCA has now yielded over $85 billion in settlements and judgments since it was enhanced through Congressional amendments in 1986. These […]
THE LARGEST EVER FALSE CLAIMS ACT SETTLEMENT UNDER MEDICARE ADVANTAGE
In an opinion issued September 24, 2025, the D.C. Circuit held in favor of a tax whistleblower in a decision that could mark a turning point for judicial review of the IRS tax whistleblower program. Although there has been no shortage of litigation around the program, wins for whistleblowers are extremely rare, especially on anything […]
The Department of Justice (DOJ) last week reported nearly $3 billion in recoveries under the False Claims Act (FCA) for fiscal year 2024. These successful FCA cases targeted fraud in healthcare, defense contracting, pandemic relief, and cybersecurity, among other areas. A significant portion, $1.67 billion, came from healthcare fraud cases, including improper billing practices and […]
Last week, the Department of Justice (DOJ) announced a $15.875 million settlement with Booz Allen Hamilton over alleged False Claims Act (FCA) violations involving a scheme to rig Department of Defense (DoD) bids using insider information. The alleged fraud centered on a Booz Allen subsidiary, Booz Allen Hamilton Engineering Services (BES), which supplied military training […]
Right before the holidays, we proudly announced a settlement of up to $100 million with Independent Health, a Western New York-based insurer, and one of its former executives. Several news outlets have since highlighted the settlement and the importance of whistleblowers in the healthcare industry, which is unfortunately a hotbed of fraud. In its case […]
Whistleblower Partners is proud to announce that our client, Teresa Ross, and the United States, have reached a settlement with Independent Health (“IH”), a Medicare Advantage Organization in Western New York, as well as its former subsidiary, DxID, and that subsidiary’s former CEO Betsy Gaffney. The settling parties will pay up to $100 million, with […]
THIS IS THE LARGEST MEDICARE ADVANTAGE SETTLEMENT WITH A HEALTH PLAN PURELY BASED ON A WHISTLEBLOWER CASE
Medicare Advantage, or Medicare Part C, is an extremely popular alternate model to traditional Medicare. In traditional Medicare, the government directly pays for services provided, known as a “fee for service” model. Under the Medicare Advantage program, the government contracts with private insurers and pays them premiums to provide coverage for Medicare-eligible beneficiaries. In this […]
Medicare, like many other insurers, often pays doctors a standardized rate based on the service they performed. Open heart surgery costs $Z, a blood test for cholesterol costs $Y, and a physical costs $X. Upcoding is a fraud that centers on healthcare providers submitting improper medical codes to insurers for reimbursement, generally for improperly high […]
