The Department of Justice announced its 2026 National Health Care Fraud Takedown on June 23: 455 defendants charged, and over $6.5 billion in alleged false claims. Federal prosecutors are moving aggressively on health care fraud, and any healthcare fraud defense lawyer reading the release sees the same message that reaches insiders sitting on evidence. The False Claims Act still gives private citizens a way to bring the next case.
What the DOJ announced
- 455 defendants charged, including 90 doctors and other licensed medical professionals
- Over $6.5 billion in alleged false claims
- Cases spanning 56 federal districts and 45 states and territories
- All 50 state Medicaid Fraud Control Units participating, a first in department history
- A record 295 Medicaid fraud defendants and over $518 million in false claims to state programs
- Over $182 million in cash, luxury vehicles, jewelry, and other assets seized
- International arrests in the Philippines, Estonia, and Kyrenia tied to previously charged schemes
The schemes ranged from fraudulent wound care allografts and hospice billing to opioid diversion, behavioral health billing, cardiovascular testing on student athletes, and Medicaid billing for services never provided. In one Southern District of Texas case detailed in the department’s press release, a single nurse practitioner allegedly ran a $906 million allograft scheme, billing Medicare an average of more than $1 million per patient.
Why whistleblowers matter to a takedown like this
The DOJ credited advanced data analytics for surfacing several of these schemes, and rightly so. Data spotted the wound care allograft spike. It flagged behavioral health providers billing for 500 or more hours a day. In another case, cross-referencing hospital admissions with outpatient claims caught providers billing for sessions on days their patients were inpatient somewhere else.
But the data mostly sees the shape of a scheme once it’s already running. Insiders see it earlier, and they see things data can’t—kickbacks disguised as consulting or marketing fees. Referral instructions given verbally so nothing lands in an email chain. Backdated chart notes written to justify billing that already went out—conversations about which claims to submit and which to bury.
That’s why the False Claims Act still drives most of the significant health care fraud cases the department brings, and why recent whistleblower cases account for so much of what DOJ recovers under the statute.
How the False Claims Act protects and pays whistleblowers
The False Claims Act (31 U.S.C. § 3729 and following sections) lets private citizens, called relators, file a qui tam lawsuit on behalf of the United States when they have evidence of fraud against a federal program. The government reviews the complaint under seal and either intervenes to take the case over or declines and lets the relator proceed alone.
If the case succeeds, the relator receives a share of the recovery. When the government intervenes, the relator’s share is generally 15% to 25%. When the government declines, and the relator wins on their own, the share can rise to 30%.
The statute also protects whistleblowers from retaliation. Section 3730(h) covers people who are discharged, demoted, harassed, or otherwise discriminated against because of protected activity, and it allows for reinstatement, double back pay, compensation for special damages, and attorney’s fees.
Two rules matter early. The first-to-file rule bars later relators from bringing the same claim, so timing counts. And the public disclosure bar limits cases built on facts already in the public record unless the relator was the original source of the information.
What kinds of conduct in the takedown look like typical False Claims Act cases?
Almost every scheme charged this year has a whistleblower analog somewhere in a filing cabinet. Common patterns:
- Kickbacks paid to marketers, sales reps, providers, or referral sources, often disguised as consulting fees or marketing payments
- Billing for medically unnecessary services, never provided, or delivered by unlicensed staff
- Upcoding, or billing for a higher-reimbursing service than what actually happened
- Falsified or backdated records created to support billing after the fact
- Targeting vulnerable populations, particularly hospice patients, homeless individuals, tribal communities, and other Medicaid beneficiaries, for schemes that require cooperative or absent patients
- Phantom-patient billing built on data purchased from third parties, like the hospice-owner defendant in the Central District of California who allegedly paid a funeral home employee for information on the recently deceased
If someone at a company saw one of these and has documentation of what they saw, that’s the profile of a False Claims Act case.
What to do if you have information about health care fraud
If you have information about health care fraud, the right first move depends on how you learned what you know, what documents exist, what your employment status is, whether the scheme is still active, and whether anyone else is already looking at it.
A few things are true in almost every case, though:
- The clock matters. The first-to-file rule means the first relator to reach the courthouse with a given set of facts is generally the only one who can pursue them. Once a scheme becomes public through news coverage or a competing filing, the window narrows further.
- Retaliation risk is real, and it’s handled very differently before an internal complaint than after one.
- What you say to a lawyer under privilege stays confidential. What you say to a supervisor, an internal ethics line, a co-worker, or an outside acquaintance generally does not.
- The mechanics of preserving evidence, reporting to the government, filing under seal, and coordinating with DOJ during the review period are technical and vary by district. They’re the kind of thing worth handling with counsel rather than working out on your own.
For most people in that position, the first step is a confidential conversation with a lawyer who handles False Claims Act cases. Our healthcare fraud defense legal team takes those calls from Atlanta and Savannah, and every consultation stays confidential regardless of whether a case moves forward.
Contact Griffin Durham Tanner & Clarkson about a False Claims Act case
Griffin Durham Tanner & Clarkson represents whistleblowers in False Claims Act cases from offices in Atlanta and Savannah. Tom Clarkson leads the firm’s False Claims Act work, and the firm has handled qui tam matters from both the plaintiff and defense sides.
If you have information about health care fraud, government contracting fraud, defense procurement fraud, or any federal program being billed for services that weren’t delivered, call (404) 891-9150 in Atlanta or (912) 867-9140 in Savannah. You can also contact us online to get started.
