What may warrant review
Patterns, not assumptions.
HHS-OIG identifies billing for services not provided, upcoding, medically unnecessary services, and improper separate billing among examples of improper claims. The agency also describes restrictions on referral payments. HHS-OIG physician guidance (opens a new tab)
- Services not providedClaims for visits, procedures, tests, or supplies that were not actually delivered.
- Coding and documentationConcerns that codes or records may misrepresent what was done.
- Medical necessity and referralsQuestions about unnecessary services or potentially unlawful referral arrangements.
A mistake or disagreement does not automatically establish fraud. The False Claims Act addresses knowing false claims and related conduct; individual facts and legal requirements matter. DOJ False Claims Act overview (opens a new tab)
Possible legal options
A report is not automatically
a whistleblower award.
The False Claims Act permits qualifying private actions on the government’s behalf, known as qui tam actions. A successful relator may receive part of a recovery, but eligibility and the outcome are not guaranteed. Department of Justice (opens a new tab)
Federal qui tam complaints are initially filed under seal for at least 60 days, with possible extensions. That does not promise permanent anonymity. Related pending actions and public disclosures can affect a potential case. 31 U.S.C. § 3730(b), (e) (opens a new tab)
Prompt advice, without public disclosure.
Ask counsel about timing, reporting obligations, prior disclosures, and the appropriate process. Do not publish accusations or post records to try to establish a claim. Do not delay immediate patient-safety or legally required reports.
Separate programs · Separate eligibility
Potential Whistleblower Awards
Some qualifying whistleblowers may receive a financial award. A tip alone does not guarantee payment, and the amounts below describe different programs, not a combined or promised recovery. DOJ tip-reward terms (opens a new tab) DOJ corporate-program FAQs (opens a new tab) 31 U.S.C. § 3730 (opens a new tab)
$10,000–$30,000
DOJ announced the Fraud Whistleblower Incentive Program (WHIP) on October 20, 2026; its detailed terms call it the Criminal Tip Rewards Pilot Program. Qualifying individuals may receive one discretionary award per distinct tip leading to covered criminal charges, ordinarily after charges are unsealed, without waiting for conviction or final forfeiture. DOJ announcement (opens a new tab) Program terms (opens a new tab)
The program covers qualifying federal healthcare offenses and related crimes. No minimum loss is required, but original, voluntary, truthful and complete information, cooperation, and other eligibility requirements apply. DOJ tip-reward FAQs (opens a new tab)
A possible share
of a recovery
A qualifying qui tam plaintiff ordinarily may receive 15%–25% of the proceeds if the government proceeds with the action, or 25%–30% if the government does not proceed and the plaintiff successfully pursues it. Statutory exceptions, reductions, and bars apply. 31 U.S.C. § 3730(d) (opens a new tab)
This is a separate civil lawsuit process, not an automatic percentage payment for submitting a criminal tip or contacting this firm. The statutory percentages are not estimates of take-home proceeds. DOJ False Claims Act overview (opens a new tab) Qui tam procedures (opens a new tab)
Forfeiture-based
awards
Eligible information leading to more than $1 million in net proceeds forfeited may qualify for a discretionary award: up to 30% of the first $100 million and up to 5% of the next $400 million. No award is calculated on amounts above $500 million; the applicable limits are shared if multiple whistleblowers qualify in the same matter. DOJ corporate-program terms (opens a new tab) Corporate-program FAQs (opens a new tab)
This program has its own eligibility, forfeiture, and other-program restrictions. It is not a promise that every Medicare or Medicaid report qualifies or that multiple awards can be added together. Program eligibility (opens a new tab) Overlapping-program guidance (opens a new tab)
Your own involvement matters.
Meaningful participation in the reported criminal activity generally disqualifies an individual from the new tip reward; DOJ allows a limited, discretionary exception for a sufficiently minimal role. Reward eligibility is not immunity from prosecution. DOJ eligibility and culpability provisions (opens a new tab)
Under the False Claims Act, planning and initiating the violation can reduce a relator’s share, and a qualifying conviction arising from the person’s role bars a share. If you are concerned about your own conduct, seek criminal-defense advice before making a submission. 31 U.S.C. § 3730(d)(3) (opens a new tab)
Read the criminal-defense informationThe new tip program permits anonymous submissions through an attorney, but DOJ must verify identity before payment and disclosure may later be required. Do not assume permanent anonymity or send patient records through this website. DOJ anonymity and confidentiality provisions (opens a new tab)
Program information reviewed November 1, 2026. Rules and guidance may change; individual eligibility, reporting procedures, and overlapping-program issues require review. No award, amount, payment date, representation, or outcome is guaranteed.
Records and privacy
Do not upload patient information.
HIPAA’s whistleblower provision has conditions, including specified recipients and good-faith requirements. Its attorney provision refers to an attorney retained by or on behalf of the workforce member or business associate to determine legal options; it is not blanket permission to upload records to a marketing website. 45 C.F.R. § 164.502(j) (opens a new tab)
Preserve relevant information lawfully. Do not alter or delete records, exceed authorized access, use another person’s credentials, or remove files for this website. Ask counsel about lawful handling before transferring sensitive materials.
Common questions
Before the first conversation.
Does reporting fraud guarantee an award?
No. The DOJ tip and corporate programs are discretionary, and an FCA recovery requires the separate statutory process and applicable eligibility. Reporting does not itself guarantee money, immunity, or permanent anonymity. DOJ tip-reward terms (opens a new tab) Corporate-program FAQs (opens a new tab) False Claims Act (opens a new tab)
Compare the potential award programs ↓What if I helped prepare the claims?
Use the criminal-defense path if you are concerned about your own conduct. Seeking whistleblower status does not automatically immunize you; the False Claims Act addresses reductions or exclusion from recovery in specified circumstances involving participation in the violation. 31 U.S.C. § 3730(d)(3) (opens a new tab)
Read the criminal-defense informationShould I use my work email?
Use a contact method you consider safe. Do not assume your employer’s email, device, or telephone is private. This page has no intake form or automatic email receipt.
Does calling mean you represent me?
No. The firm must review conflicts and decide whether it can offer representation. Do not rely on it to act, file a case, or protect a deadline unless that has been expressly agreed.
Should I send documents now?
No. Start with minimal screening. Do not send patient identifiers, screenshots, files, or detailed allegations through this site or ordinary email. Ask the office what, if anything, should be supplied after conflict and disclosure review.