The government’s healthcare spending is put at risk because of fraud each year. Thankfully, there are plenty of brave whistleblowers who, with the help of a skilled healthcare fraud attorney, stand up to uncover fraud and hold wrongdoers accountable.
At Bracker & Marcus LLC, we represent whistleblowers nationwide, handling fraud cases involving Medicare, Medicaid, TRICARE, Federal Employee Healthcare Benefits, and Veterans Administration programs. Our team has decades of experience in False Claims Act litigation, and we are committed to protecting whistleblowers, exposing fraud, and recovering taxpayer dollars. If you suspect healthcare fraud, we are here to guide you every step of the way.
Why choose Bracker & Marcus LLC?
- Decades of experience in False Claims Act litigation.
- Proven track record of multimillion-dollar fraud recoveries.
- Whistleblower protection advocacy—we fight to keep you safe.
- You don’t pay unless we win.
Thinking about reporting fraud? We’re here to guide you every step of the way. Speak with an attorney now.
Our healthcare fraud attorneys serve clients nationwide
Our skilled attorneys represent U.S. whistleblowers in federal and state courts.
Federal level
- Most Medicare and Medicaid fraud cases fall under federal jurisdiction.
- Federal courts have more experience with False Claims Act cases.
- Filing in federal court often allows for higher whistleblower rewards.
We come to you
- We are permanently admitted to multiple federal courts across the U.S.
- We can seek special admission in any federal jurisdiction.
No charge for local counsel
- When necessary, we bring in local counsel—at no cost to you.
- You get the benefit of our FCA expertise and local legal experience.
Case success storiesAt Bracker & Marcus LLC, we have helped whistleblowers expose fraud and recover millions for the government. |
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| AlixaRx LLC – $2.75 million
AlixaRx, a national pharmacy provider for long-term care facilities, paid $2.75 million to settle claims that it improperly dispensed opioids and other controlled substances without valid prescriptions. A whistleblower pharmacist exposed the company’s abuse of emergency prescription provisions, leading to false claims under the Controlled Substances Act. |
| Pediatric Services of America – $7 million
This home nursing provider for medically fragile children paid $7 million in a landmark False Claims Act settlement, marking the first case where a healthcare provider was held accountable for failing to investigate overpayments on its books, as required by the Affordable Care Act. |
| Mitias Orthopaedics – $1.9 million
This orthopedic clinic settled on the eve of trial our client’s allegations that it billed Medicare and Medicaid for brand name viscosupplementation agents when it was using cheaper, compounded products purchased from specialty pharmacies. |
| Capstone Diagnostics – $14.3 million
This lab-testing company settled claims that it profited from the pandemic by performing and billing for expensive respiratory pathogen panels when ordering physicians had only authorized COVID-19 testing, a fraud referred to as “lab stacking.” The owner pled guilty to criminal charges. |
| Universal Health Services, Inc. – $117 million
This psychiatric hospital chain paid $117 million to resolve allegations of widespread fraud, including billing for unnecessary treatments, unqualified inpatient admissions, excessive patient stays, and improper use of physical and chemical restraints. The case also highlighted staffing deficiencies and inadequate supervision. |
| CRH Healthcare – $1.6 million
This chain of urgent care clinics settled allegations that it billed high level evaluation and management codes (upcoding) for drive-thru COVID testing, even when patients had no symptoms or exposure to the virus. |
| Beaumont Hospital Systems – $84 million
This hospital system settled our client’s allegations that it had provided kickbacks to cardiologists in exchange for referrals. |
Think you’ve witnessed fraud? Let’s discuss your case confidentially. Schedule a free evaluation today.
Common types of healthcare fraud our firm handles
Healthcare fraud involves intentionally deceiving or misrepresenting information in healthcare transactions to gain unauthorized benefits. It targets government programs like Medicare and Medicaid, private insurers, or individual patients. The U.S. government has made healthcare fraud a major enforcement priority, primarily under the False Claims Act (FCA), a powerful tool to combat fraudulent schemes in the healthcare industry.
Healthcare fraud takes many forms, exploiting government healthcare programs like Medicare and Medicaid. Below are some of the most common types of fraud we investigate and litigate.
Some providers submit claims for services that were never performed, essentially fabricating patient visits or medical procedures to defraud the government.
By using incorrect billing codes, providers can falsely claim higher reimbursements than they are entitled to. This scheme inflates costs by exaggerating the complexity or necessity of medical services.
Medical professionals sometimes prescribe treatments or procedures that patients do not need to boost their earnings, leading to inflated healthcare costs and potential harm to patients.
Kickbacks occur when providers receive unlawful financial incentives—such as cash or vacations—for patient referrals or drug prescriptions, creating conflicts of interest that prioritize profit over patient care.
- Anti-Kickback Statute [42 U.S.C. § 1320a-7b(b)]
Compounding pharmacies customize medications for patient needs, but some exploit the system by marketing unnecessary compounded drugs or inflating prescription costs through fraudulent billing.
Pharmacies may substitute generic drugs for brand-name medications while billing the government at higher rates, violating False Claims Act provisions designed to ensure fair pricing.
Additional healthcare fraud cases we handle
Beyond common fraud schemes, numerous other deceptive practices can result in False Claims Act violations. The following cases illustrate various ways in which providers, hospitals, and pharmaceutical companies engage in fraudulent activity.
Physicians are prohibited from referring patients to healthcare facilities they own unless a legal exception applies. Violations often result in unnecessary procedures performed for financial gain.
Fraudulent billing occurs when providers either bill a group of procedures as a single code while performing only one service (bundling) or separate services that should be billed together to receive excessive reimbursements (unbundling).
Hospitals and healthcare facilities submit inaccurate cost reports to the government, manipulating data to obtain higher Medicare reimbursements.
Some fraudulent providers bill the government for nonexistent patients or claim reimbursement for services never provided, effectively creating false claims out of thin air.
Billing government programs for drugs or medical devices that are unapproved, defective, or imported illegally not only constitutes fraud but also endangers patient safety.
Billing under a physician’s name for services actually performed by midlevel providers—without proper supervision—can result in overpayments and False Claims Act violations.
Pharmaceutical companies sometimes market drugs for unapproved uses, leading to fraudulent claims when doctors unknowingly submit bills for these off-label treatments.
Federal law requires pharmaceutical companies to offer the lowest price for Medicaid purchases. Concealing actual pricing data or making exclusive deals with select buyers violates this rules.
Some pharmaceutical companies artificially inflate drug prices so providers and pharmacies can profit from the gap between actual costs and government reimbursements, leading to kickback violations.
Medical device manufacturers that knowingly distribute faulty or noncompliant devices to government healthcare programs may be held liable under the False Claims Act.
Just about anyone in the healthcare arena can commit fraud
A dizzying array of people and entities can commit healthcare fraud. Whistleblowers who contact a medical fraud attorney can expose them via a False Claims Act complaint:
- Healthcare facilities, including hospitals, clinics, long-term care facilities, inpatient rehabilitation facilities, and laboratory/diagnostic testing facilities
- Healthcare providers, including physicians, therapists, and hospice providers
- Pharmaceutical organizations, including retail, compound, or long-term care facility pharmacies, pharmaceutical manufacturers and distributors, and medical device manufacturers and distributors
- Government contractors, including group purchasing organizations, Medicare Advantage Plan providers, and electronic health records software providers
The False Claims Act and its role in healthcare fraud enforcement
The False Claims Act (FCA) (31 U.S.C. §§ 3729–3733) is the federal government’s most powerful tool to combat healthcare fraud. This law allows the government to pursue fraudulent providers and includes a qui tam provision, which enables whistleblowers to file lawsuits on the government’s behalf.
Violators of the FCA may face:
- Treble damages (three times the fraudulent claim amount).
- Per-claim penalties for each false submission.
- Whistleblower rewards ranging from 15% to 30% of the total recovery.
What does it mean to be a whistleblower in a healthcare fraud case?
Being a whistleblower in a healthcare fraud case means reporting fraudulent activity against government healthcare programs like Medicare and Medicaid, often under the False Claims Act (FCA). Whistleblowers—typically employees, contractors, or insiders—come forward with evidence of fraud, such as false billing, kickbacks, or medically unnecessary procedures. By filing a qui tam lawsuit, whistleblowers help the government recover stolen taxpayer funds and may receive a reward of 15-30% of the recovered amount. They are also protected from retaliation under federal law.
Whistleblower protections
We understand that fear of retaliation is a major concern for whistleblowers. Federal law protects you from:
- Wrongful termination
- Demotions or harassment
- Blacklisting or threats
If you face retaliation after reporting fraud, we aggressively fight to protect your rights and seek compensation.
How long does it take to be rewarded for a healthcare fraud case?
Unfortunately, there is no telling how long a government investigation into healthcare fraud will take. So many variables factor into how long a case might take that it is impossible to predict, even for experienced healthcare fraud attorneys like us.
Ballpark answer
When pressed, we find that a straightforward case may be intervened and settled after approximately 2-3 years, while large or complicated matters may take longer. Of course, if a case is determined to not be viable that may occur in a far shorter period of time.
If your reaction is shock and dismay at how long these cases take, let’s discuss further why this is so.
Government extensions
The initial seal period is for 60 days, but unless your case has zero merit, the government is certain to seek an extension. Usually, it requests a six-month extension to continue its investigation.
Good cases aren’t open-and-shut
Good cases can often take a very long time to investigate. Mountains of evidence may be produced, all of which need to be processed and reviewed.
Even seemingly simple cases can require a file-by-file review to determine which patients were subject to the fraud and which were not. It is not enough to say that fraud occurred generally, but rather, the government must prove exactly when, where, and how it occurred, and to what extent. There is much to do, and the government wants to dot its I’s and cross its T’s before the case is unsealed.
If the government concludes its investigation and intervenes, there is no telling how long a settlement will take, if there is to be a settlement.
Settlement process, step one: Disclose case to defendants
First, the government must disclose the existence of the case with the defendants. Remember, although the whistleblower and government have been tirelessly working on this case for years, because of the federal seal, it is only once the investigation is complete that defendants often learn they are being investigated in the first place.
Settlement process, step two: Defense preparations
Once the defendant wraps its head around the fact that it is the subject of a major lawsuit and complex government investigation, it must retain counsel, review the allegations, and prepare its defense.
The government wants to hear the defendants’ justifications now, not later, and sometimes it turns out the defendant had a very good – and legal – reason for doing what it did. This process can take many months.
Settlement process, step three: Potential settlement
If the government is unconvinced, a defendant may decide to settle. If that happens, that process can take many months as well, as the parties hash out not only the exact dollar amount to be returned to the federal fisc but also many details of the settlement, such as:
- Timing of payments
Release language
Conduct covered by the settlement
What part of the settlement might be tax-deductible
Settlement process, step four: Defense requests a payment analysis
If a defendant does not have enough money to pay back the government what it thinks it should settle for, it can request an “ability to pay analysis.” This is yet another lengthy process, and discussions are essentially shut down while the defendant gathers its financial information and prepares sworn affidavits as to its solvency.
Settlement process, step five: Frequent check-ins to ensure fraud does not continue
Often, the affected agency requires something called a Corporate Integrity Agreement to ensure that the defendant does not continue to commit fraud. In the case of Medicare fraud, for example, the Department of Health and Human Services may request annual audits, training, license suspensions, and other requirements as a condition of settlement.
This negotiation frequently takes longer than the settlement itself, as Corporate Integrity Agreements can be expensive and burdensome.
How trial affects the timeline
If the case is litigated, there is no telling how long that will take, either. Certain motions – which are routinely filed in False Claims Act cases – can take months for the court to rule on, all the while the litigation is at a standstill.
Needless to say, litigating a False Claims Act case to successful completion is likely to take years, although a settlement could occur at any point in the process.
The last step: Whistleblower negotiations
Once the settlement or judgment is complete, the whistleblower still must negotiate a realtor’s share with the government. As discussed on our page “How are Medicare whistleblower rewards paid?”, realtors are generally entitled to between 15 and 25% for an intervened case, and between 25% and 30% for a declined case.
If the whistleblower can reach an agreement with the government, then it is just a matter of processing the payment. If not, then the parties must go to court and litigate the issue.
“First-to-file” exception
A similar problem occurs if there are multiple cases alleging similar facts. Under the False Claims Act, only the “first-to-file” of a certain claim is entitled to an award. But whether a certain relator is first-to-file is not always obvious. Did he name the same defendants? Are states involved in the settlement? Are claims the same? It is rare that cases perfectly overlap so that the answer is clear.
Unfortunately, litigating first-to-file issues can easily tie the money up for months, if not years, as the court is in no rush to resolve these questions and the government is unwilling to pay even a dime until it knows who is entitled to the money.
A healthcare fraud attorney is ready to help
Exposing healthcare fraud is crucial to protecting taxpayer dollars and ensuring ethical healthcare practices. At Bracker & Marcus LLC, we stand with whistleblowers and provide the expert legal support needed to fight fraud and secure justice. If you suspect healthcare fraud, contact us today for a confidential case evaluation.