{"id":10,"date":"2026-11-02T17:52:00","date_gmt":"2026-11-02T17:52:00","guid":{"rendered":"https:\/\/mimslawtexas.com\/?page_id=10"},"modified":"2026-11-02T17:52:00","modified_gmt":"2026-11-02T17:52:00","slug":"healthcare-whistleblowers","status":"publish","type":"page","link":"https:\/\/mimslawtexas.com\/?page_id=10","title":{"rendered":"Healthcare Whistleblower Information"},"content":{"rendered":"\r\n<section class=\"bdmhc-route-hero bdmhc-wrap\">\r\n<div><a class=\"bdmhc-breadcrumb\" href=\"{{BDMHC_HUB}}\">\u2190 Back to both paths<\/a>\r\n<p class=\"bdmhc-eyebrow\">Whistleblower information<\/p>\r\n<h1>You see a billing concern.<br \/>Understand your options.<\/h1>\r\n<p class=\"bdmhc-lede\">For professionals and employees considering how to raise concerns about suspected Medicare or Medicaid fraud.<\/p>\r\n<a class=\"bdmhc-button\" href=\"#contact\">Ask about an initial review <span class=\"bdmhc-arrow\" aria-hidden=\"true\">\u2197<\/span><\/a><\/div>\r\n<aside class=\"bdmhc-route-note\"><span class=\"bdmhc-eyebrow\">Start here<\/span>\r\n<h2>Names first.<br \/>Facts later.<\/h2>\r\n<p>Before sending allegations, identify the people and organizations needed for a conflict check. Do not send patient records or collect new documents for this website.<\/p>\r\n<a href=\"{{BDMHC_DEFENSE}}\">Concerned about your own involvement? <span class=\"bdmhc-arrow\" aria-hidden=\"true\">\u2197<\/span><\/a><\/aside>\r\n<\/section>\r\n<div class=\"bdmhc-wrap bdmhc-article-layout\">\r\n<aside class=\"bdmhc-contents\">\r\n<p class=\"bdmhc-eyebrow\">On this path<\/p>\r\n<a href=\"#concerns\">Billing concerns<\/a><a href=\"#claims\">Possible legal options<\/a><a href=\"#awards\">Potential awards<\/a><a href=\"#privacy\">Records and privacy<\/a><a href=\"#questions\">Common questions<\/a><a href=\"#contact\">Initial contact<\/a><\/aside>\r\n<div class=\"bdmhc-article-content\">\r\n<section id=\"concerns\">\r\n<p class=\"bdmhc-eyebrow\">What may warrant review<\/p>\r\n<h2>Patterns, not assumptions.<\/h2>\r\n<p>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. <a class=\"bdmhc-citation\" href=\"https:\/\/oig.hhs.gov\/documents\/physicians-resources\/947\/roadmap_web_version.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">HHS-OIG physician guidance<span class=\"bdmhc-sr-only\"> (opens a new tab)<\/span><\/a><\/p>\r\n<ul class=\"bdmhc-editorial-list\">\r\n<li><strong>Services not provided<\/strong>Claims for visits, procedures, tests, or supplies that were not actually delivered.<\/li>\r\n<li><strong>Coding and documentation<\/strong>Concerns that codes or records may misrepresent what was done.<\/li>\r\n<li><strong>Medical necessity and referrals<\/strong>Questions about unnecessary services or potentially unlawful referral arrangements.<\/li>\r\n<\/ul>\r\n<p>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. <a class=\"bdmhc-citation\" href=\"https:\/\/www.justice.gov\/civil\/false-claims-act\" target=\"_blank\" rel=\"noopener noreferrer\">DOJ False Claims Act overview<span class=\"bdmhc-sr-only\"> (opens a new tab)<\/span><\/a><\/p>\r\n<\/section>\r\n<section id=\"claims\">\r\n<p class=\"bdmhc-eyebrow\">Possible legal options<\/p>\r\n<h2>A report is not automatically<br \/>a whistleblower award.<\/h2>\r\n<p>The False Claims Act permits qualifying private actions on the government&#8217;s behalf, known as qui tam actions. A successful relator may receive part of a recovery, but eligibility and the outcome are not guaranteed. <a class=\"bdmhc-citation\" href=\"https:\/\/www.justice.gov\/civil\/false-claims-act\" target=\"_blank\" rel=\"noopener noreferrer\">Department of Justice<span class=\"bdmhc-sr-only\"> (opens a new tab)<\/span><\/a><\/p>\r\n<p>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. <a class=\"bdmhc-citation\" href=\"https:\/\/uscode.house.gov\/view.xhtml?edition=prelim&amp;req=granuleid:USC-prelim-title31-section3730&amp;num=0&amp;hl=false\" target=\"_blank\" rel=\"noopener noreferrer\">31 U.S.C. \u00a7 3730(b), (e)<span class=\"bdmhc-sr-only\"> (opens a new tab)<\/span><\/a><\/p>\r\n<div class=\"bdmhc-callout\">\r\n<h3>Prompt advice, without public disclosure.<\/h3>\r\n<p>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.<\/p>\r\n<\/div>\r\n<\/section>\r\n<section id=\"awards\">\r\n<p class=\"bdmhc-eyebrow\">Separate programs \u00b7 Separate eligibility<\/p>\r\n<h2>Potential Whistleblower Awards<\/h2>\r\n<p>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. <a class=\"bdmhc-citation\" href=\"https:\/\/www.justice.gov\/fraud\/national-fraud-enforcement-division-criminal-tip-rewards-pilot-program\" target=\"_blank\" rel=\"noopener noreferrer\">DOJ tip-reward terms<span class=\"bdmhc-sr-only\"> (opens a new tab)<\/span><\/a> <a class=\"bdmhc-citation\" href=\"https:\/\/www.justice.gov\/criminal\/whistleblower\/frequently-asked-questions\" target=\"_blank\" rel=\"noopener noreferrer\">DOJ corporate-program FAQs<span class=\"bdmhc-sr-only\"> (opens a new tab)<\/span><\/a> <a class=\"bdmhc-citation\" href=\"https:\/\/uscode.house.gov\/us\/usc\/119-120\/t31\/s3730\/\" target=\"_blank\" rel=\"noopener noreferrer\">31 U.S.C. \u00a7 3730<span class=\"bdmhc-sr-only\"> (opens a new tab)<\/span><\/a><\/p>\r\n<div class=\"bdmhc-award-option\">\r\n<div class=\"bdmhc-award-heading\"><span class=\"bdmhc-eyebrow\">New early-stage tip reward<\/span>\r\n<h3>$10,000\u2013$30,000<\/h3>\r\n<\/div>\r\n<div>\r\n<p>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. <a class=\"bdmhc-citation\" href=\"https:\/\/www.justice.gov\/opa\/pr\/justice-department-announces-innovative-whistleblower-rewards-program-combat-fraud\" target=\"_blank\" rel=\"noopener noreferrer\">DOJ announcement<span class=\"bdmhc-sr-only\"> (opens a new tab)<\/span><\/a> <a class=\"bdmhc-citation\" href=\"https:\/\/www.justice.gov\/fraud\/national-fraud-enforcement-division-criminal-tip-rewards-pilot-program\" target=\"_blank\" rel=\"noopener noreferrer\">Program terms<span class=\"bdmhc-sr-only\"> (opens a new tab)<\/span><\/a><\/p>\r\n<p>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. <a class=\"bdmhc-citation\" href=\"https:\/\/www.justice.gov\/fraud\/criminal-tip-rewards-pilot-program-faqs\" target=\"_blank\" rel=\"noopener noreferrer\">DOJ tip-reward FAQs<span class=\"bdmhc-sr-only\"> (opens a new tab)<\/span><\/a><\/p>\r\n<\/div>\r\n<\/div>\r\n<div class=\"bdmhc-award-option\">\r\n<div class=\"bdmhc-award-heading\"><span class=\"bdmhc-eyebrow\">Federal False Claims Act<\/span>\r\n<h3>A possible share<br \/>of a recovery<\/h3>\r\n<\/div>\r\n<div>\r\n<p>A qualifying qui tam plaintiff ordinarily may receive 15%\u201325% of the proceeds if the government proceeds with the action, or 25%\u201330% if the government does not proceed and the plaintiff successfully pursues it. Statutory exceptions, reductions, and bars apply. <a class=\"bdmhc-citation\" href=\"https:\/\/uscode.house.gov\/us\/usc\/119-120\/t31\/s3730\/\" target=\"_blank\" rel=\"noopener noreferrer\">31 U.S.C. \u00a7 3730(d)<span class=\"bdmhc-sr-only\"> (opens a new tab)<\/span><\/a><\/p>\r\n<p>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. <a class=\"bdmhc-citation\" href=\"https:\/\/www.justice.gov\/civil\/false-claims-act\" target=\"_blank\" rel=\"noopener noreferrer\">DOJ False Claims Act overview<span class=\"bdmhc-sr-only\"> (opens a new tab)<\/span><\/a> <a class=\"bdmhc-citation\" href=\"https:\/\/uscode.house.gov\/us\/usc\/119-120\/t31\/s3730\/\" target=\"_blank\" rel=\"noopener noreferrer\">Qui tam procedures<span class=\"bdmhc-sr-only\"> (opens a new tab)<\/span><\/a><\/p>\r\n<\/div>\r\n<\/div>\r\n<div class=\"bdmhc-award-option\">\r\n<div class=\"bdmhc-award-heading\"><span class=\"bdmhc-eyebrow\">DOJ corporate whistleblower pilot<\/span>\r\n<h3>Forfeiture-based<br \/>awards<\/h3>\r\n<\/div>\r\n<div>\r\n<p>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. <a class=\"bdmhc-citation\" href=\"https:\/\/www.justice.gov\/criminal\/media\/1400041\/dl\" target=\"_blank\" rel=\"noopener noreferrer\">DOJ corporate-program terms<span class=\"bdmhc-sr-only\"> (opens a new tab)<\/span><\/a> <a class=\"bdmhc-citation\" href=\"https:\/\/www.justice.gov\/criminal\/whistleblower\/frequently-asked-questions\" target=\"_blank\" rel=\"noopener noreferrer\">Corporate-program FAQs<span class=\"bdmhc-sr-only\"> (opens a new tab)<\/span><\/a><\/p>\r\n<p>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. <a class=\"bdmhc-citation\" href=\"https:\/\/www.justice.gov\/criminal\/media\/1400041\/dl\" target=\"_blank\" rel=\"noopener noreferrer\">Program eligibility<span class=\"bdmhc-sr-only\"> (opens a new tab)<\/span><\/a> <a class=\"bdmhc-citation\" href=\"https:\/\/www.justice.gov\/criminal\/whistleblower\/frequently-asked-questions\" target=\"_blank\" rel=\"noopener noreferrer\">Overlapping-program guidance<span class=\"bdmhc-sr-only\"> (opens a new tab)<\/span><\/a><\/p>\r\n<\/div>\r\n<\/div>\r\n<div class=\"bdmhc-callout\">\r\n<h3>Your own involvement matters.<\/h3>\r\n<p>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. <a class=\"bdmhc-citation\" href=\"https:\/\/www.justice.gov\/fraud\/national-fraud-enforcement-division-criminal-tip-rewards-pilot-program\" target=\"_blank\" rel=\"noopener noreferrer\">DOJ eligibility and culpability provisions<span class=\"bdmhc-sr-only\"> (opens a new tab)<\/span><\/a><\/p>\r\n<p>Under the False Claims Act, planning and initiating the violation can reduce a relator&#8217;s share, and a qualifying conviction arising from the person&#8217;s role bars a share. If you are concerned about your own conduct, seek criminal-defense advice before making a submission. <a class=\"bdmhc-citation\" href=\"https:\/\/uscode.house.gov\/us\/usc\/119-120\/t31\/s3730\/\" target=\"_blank\" rel=\"noopener noreferrer\">31 U.S.C. \u00a7 3730(d)(3)<span class=\"bdmhc-sr-only\"> (opens a new tab)<\/span><\/a><\/p>\r\n<a class=\"bdmhc-inline-route\" href=\"{{BDMHC_DEFENSE}}\">Read the criminal-defense information <span class=\"bdmhc-arrow\" aria-hidden=\"true\">\u2197<\/span><\/a><\/div>\r\n<p class=\"bdmhc-award-note\">The 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. <a class=\"bdmhc-citation\" href=\"https:\/\/www.justice.gov\/fraud\/national-fraud-enforcement-division-criminal-tip-rewards-pilot-program\" target=\"_blank\" rel=\"noopener noreferrer\">DOJ anonymity and confidentiality provisions<span class=\"bdmhc-sr-only\"> (opens a new tab)<\/span><\/a><\/p>\r\n<p class=\"bdmhc-small\">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.<\/p>\r\n<\/section>\r\n<section id=\"privacy\">\r\n<p class=\"bdmhc-eyebrow\">Records and privacy<\/p>\r\n<h2>Do not upload patient information.<\/h2>\r\n<p>HIPAA&#8217;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. <a class=\"bdmhc-citation\" href=\"http:\/\/www.ecfr.gov\/current\/title-45\/subtitle-A\/subchapter-C\/part-164\/subpart-E\/section-164.502\" target=\"_blank\" rel=\"noopener noreferrer\">45 C.F.R. \u00a7 164.502(j)<span class=\"bdmhc-sr-only\"> (opens a new tab)<\/span><\/a><\/p>\r\n<p>Preserve relevant information lawfully. Do not alter or delete records, exceed authorized access, use another person&#8217;s credentials, or remove files for this website. Ask counsel about lawful handling before transferring sensitive materials.<\/p>\r\n<\/section>\r\n<section id=\"questions\" class=\"bdmhc-faq\">\r\n<p class=\"bdmhc-eyebrow\">Common questions<\/p>\r\n<h2>Before the first conversation.<\/h2>\r\n<details>\r\n<summary>Does reporting fraud guarantee an award?<\/summary>\r\n<p>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. <a class=\"bdmhc-citation\" href=\"https:\/\/www.justice.gov\/fraud\/national-fraud-enforcement-division-criminal-tip-rewards-pilot-program\" target=\"_blank\" rel=\"noopener noreferrer\">DOJ tip-reward terms<span class=\"bdmhc-sr-only\"> (opens a new tab)<\/span><\/a> <a class=\"bdmhc-citation\" href=\"https:\/\/www.justice.gov\/criminal\/whistleblower\/frequently-asked-questions\" target=\"_blank\" rel=\"noopener noreferrer\">Corporate-program FAQs<span class=\"bdmhc-sr-only\"> (opens a new tab)<\/span><\/a> <a class=\"bdmhc-citation\" href=\"https:\/\/uscode.house.gov\/us\/usc\/119-120\/t31\/s3730\/\" target=\"_blank\" rel=\"noopener noreferrer\">False Claims Act<span class=\"bdmhc-sr-only\"> (opens a new tab)<\/span><\/a><\/p>\r\n<a href=\"#awards\">Compare the potential award programs \u2193<\/a><\/details><details>\r\n<summary>What if I helped prepare the claims?<\/summary>\r\n<p>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. <a class=\"bdmhc-citation\" href=\"https:\/\/uscode.house.gov\/view.xhtml?edition=prelim&amp;req=granuleid:USC-prelim-title31-section3730&amp;num=0&amp;hl=false\" target=\"_blank\" rel=\"noopener noreferrer\">31 U.S.C. \u00a7 3730(d)(3)<span class=\"bdmhc-sr-only\"> (opens a new tab)<\/span><\/a><\/p>\r\n<a href=\"{{BDMHC_DEFENSE}}\">Read the criminal-defense information <span class=\"bdmhc-arrow\" aria-hidden=\"true\">\u2197<\/span><\/a><\/details><details>\r\n<summary>Should I use my work email?<\/summary>\r\n<p>Use a contact method you consider safe. Do not assume your employer&#8217;s email, device, or telephone is private. This page has no intake form or automatic email receipt.<\/p>\r\n<\/details><details>\r\n<summary>Does calling mean you represent me?<\/summary>\r\n<p>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.<\/p>\r\n<\/details><details>\r\n<summary>Should I send documents now?<\/summary>\r\n<p>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.<\/p>\r\n<\/details><\/section>\r\n<\/div>\r\n<\/div>\r\n<section id=\"contact\" class=\"bdmhc-contact-block\">\r\n<div class=\"bdmhc-wrap bdmhc-contact-grid\">\r\n<div>\r\n<p class=\"bdmhc-eyebrow\">Your next step<\/p>\r\n<h2>Ask about an initial<br \/>whistleblower review.<\/h2>\r\n<p>Call and identify the type of inquiry. Provide only the names and safe-contact information requested for initial screening; ask the office how to proceed before describing substantive facts.<\/p>\r\n<\/div>\r\n<div class=\"bdmhc-contact-aside\"><a class=\"bdmhc-button\" href=\"tel:+19035952169\">Call 903-595-2169 <span class=\"bdmhc-arrow\" aria-hidden=\"true\">\u2197<\/span><\/a>\r\n<p>Safe contact only. No patient records.<br \/>No detailed admissions or allegations in voicemail.<\/p>\r\n<p class=\"bdmhc-small\">The same firm receives both types of inquiry. Choosing a path is not conflict clearance, acceptance, or consent to represent people with adverse interests. No online form is connected.<\/p>\r\n<\/div>\r\n<\/div>\r\n<\/section>\r\n","protected":false},"excerpt":{"rendered":"<p>\u2190 Back to both paths Whistleblower information You see a billing concern.Understand your options. For professionals and employees considering how to raise concerns about suspected Medicare or Medicaid fraud. Ask about an initial review \u2197 Start here Names first.Facts later. Before sending allegations, identify the people and organizations needed for a conflict check. Do not [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-10","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/mimslawtexas.com\/index.php?rest_route=\/wp\/v2\/pages\/10","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/mimslawtexas.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/mimslawtexas.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/mimslawtexas.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/mimslawtexas.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=10"}],"version-history":[{"count":1,"href":"https:\/\/mimslawtexas.com\/index.php?rest_route=\/wp\/v2\/pages\/10\/revisions"}],"predecessor-version":[{"id":14,"href":"https:\/\/mimslawtexas.com\/index.php?rest_route=\/wp\/v2\/pages\/10\/revisions\/14"}],"wp:attachment":[{"href":"https:\/\/mimslawtexas.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=10"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}