Do you suspect healthcare fraud?
Healthcare fraud against the government steals from the sickest and most vulnerable among us. Help stop the theft of billions of dollars annually!
I suspect healthcare fraud – Let’s chat
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100% free & confidential
Healthcare Fraud Whistleblower Attorneys in North & South Carolina
Helping You Blow the Whistle on Healthcare Fraud Against the Government
Healthcare fraud costs American taxpayers billions of dollars every year. Dishonest healthcare providers, pharmaceutical companies, and medical device manufacturers steal from vital government programs like Medicare and Medicaid, and every citizen pays the price.
The scale of this problem is staggering. In the fiscal year ending September 30, 2024, the U.S. Department of Justice recovered more than $2.9 billion from settlements and judgments in fraud cases under the False Claims Act. Of that, $1.67 billion came directly from the healthcare industry — from managed care providers, hospitals, pharmacies, pharmaceutical companies, laboratories, and physicians who put profits ahead of the law and innocent people.
If you suspect this type of fraud, you may be in a unique and powerful position to help try to stop it.
The healthcare fraud whistleblower attorneys at Carolina Whistleblower Attorneys help everyday people stand up to corporate greed. Blowing the whistle is a courageous decision, and we are here to help you determine if you should move forward with a whistleblower lawsuit. Our mission is to be the bridge between your courage and accountability for fraud against the government.
That’s why we offer a free, 100% confidential case evaluation to help you understand your rights, your protections, and your options. Let’s talk.
Key Takeaways
- The federal False Claims Act (FCA) is the primary tool used to combat healthcare fraud against government programs like Medicare and Medicaid.
- Private citizens with knowledge of fraud, known as “relators,” can file a qui tam lawsuit on behalf of the government.
- Relators may be entitled to a reward of up to 30% of the government’s total recovery in a successful case.
- The FCA includes strong anti-retaliation provisions to protect employees who report fraud from being fired, demoted, or harassed.
- Common types of healthcare fraud include billing for services not rendered, upcoding, kickbacks, and off-label marketing.
Why choose Carolina Whistleblower Attorneys?
If you suspect healthcare fraud against the government, choosing the right legal team for you can make all the difference. You want an attorney with the experience and knowledge to handle these high-stakes cases. We’ve represented dozens of qui tam whistleblowers, with tens of millions of dollars in total settlements.1 Here is what you should know about Carolina Whistleblower Attorneys:
Led by a former U.S. Attorney with national recognition
Our whistleblower team is led by Bill Nettles, a former White House-appointed U.S. Attorney for the District of South Carolina. During his tenure, Bill’s office helped the government recover over $307 million in fraudulently obtained funds, and he helped lead the nation in whistleblower recoveries, bringing the state to the top four in the country.¹,⁴ He has inside knowledge of how the government investigates and prosecutes these cases, and he knows how to approach one of the most critical elements of the whistleblower process: the presentation of your case to the government.
A mission-driven team that believes in you
We are passionate about our work. Our mission is to stamp out corporate greed while protecting those who have the courage to come forward and try to hold fraudsters accountable. We operate under a You-First Policy, meaning we won’t advise you to move forward unless we are confident it is the right course of action for you.
What is healthcare fraud under the False Claims Act?
The primary legal tool for fighting fraud against the government is the federal False Claims Act (FCA). Originally signed into law by President Abraham Lincoln to combat fraud by Civil War defense contractors, the FCA is often called the “Lincoln Law.” It imposes significant financial penalties on any person or company that knowingly submits a false or fraudulent claim for payment to the U.S. government.
In the healthcare context, this means any entity that bills government-funded healthcare programs like Medicare, Medicaid, or TRICARE may be held liable for fraud. The law punishes not only outright, intentional lies but also “reckless disregard” for the truth, which can include systemic billing errors that result in overpayment. A recovery under the FCA can be as much as three times the amount of the fraudulent billing — known as “treble damages” — plus steep penalties for each false claim submitted.
Common examples of healthcare fraud
Healthcare fraud can take many forms, from simple overbilling to complex, multi-state schemes. If you’ve witnessed any of the following activities, you may have the foundation for a whistleblower case:
- Billing for services not rendered: Sometimes called “phantom billing,” this occurs when a provider bills Medicare or Medicaid for appointments, procedures, tests, or consultations that never happened.
- Upcoding and unbundling: “Upcoding” is the practice of billing for a more expensive service or procedure than the one that was actually provided. For example, a clinic bills for a complex, 45-minute consultation with a licensed physician when the patient only had a brief, 10-minute check-in with a nurse practitioner. “Unbundling” involves billing separately for services that are typically grouped together under a single, less expensive billing code.
- Lack of medical necessity: A provider may be committing fraud if they perform and bill for tests, procedures, or treatments that are not medically necessary for the patient’s condition, simply to increase their revenue from government programs.
- Illegal kickbacks and self-referrals: The Anti-Kickback Statute (AKS) and the Stark Law prohibit doctors from receiving payments or other financial incentives in exchange for referring patients for services that are paid for by Medicare or Medicaid. This can include a lab paying a physician for referrals or a hospital offering a doctor a below-market office lease in exchange for patient admissions. Violations of these laws can serve as the basis for a False Claims Act lawsuit.
- Pharmaceutical and medical device fraud: This includes a wide range of illegal activities, such as a drug company promoting “off-label” uses of a medication (uses not approved by the FDA) and causing doctors to bill Medicare for those unapproved uses, or a device manufacturer knowingly selling hospitals defective products that will be used in government-funded procedures.
- Improper credentialing: Fraud can occur when a company bills for services under the name of a properly credentialed doctor, when in fact the care was provided by someone whose credentials had lapsed or were never obtained.
If you suspect fraud, you don’t need to have every piece of evidence to take the first step. Our experienced team can help you evaluate the situation. We have the experience to identify hidden fraud that often goes missed.
Our experience in action: Holding healthcare companies accountable
Fraud and improper billing practices need not include a low standard of care or even a lack of care, as evidenced in a case handled by our own Bill Nettles and Fran Trapp. South Carolina’s largest urgent care provider and its management company agreed to pay $22.5 million in a whistleblower action to settle claims accusing them of shady billing practices.¹
The problem arose from “billing credentials” – a requirement for billing to the insurers. The companies allegedly failed to properly obtain or renew credentials for some of its doctors, and instead of waiting or finding a temporary solution, billed the care from doctors without credentials under doctors who had them.
In another False Claims Act case handled by Bill Nettles when he was the U.S. Attorney for the District of South Carolina, two cardiovascular testing laboratories paid $48.5 million to resolve allegations of a bribery, kickback, and fraud scheme.¹,⁴ They had allegedly paid kickbacks to physicians for referrals and then billed federal health care programs for medically unnecessary testing.
Your role as a whistleblower: The power of a qui tam lawsuit
The False Claims Act contains a unique and powerful provision known as “qui tam.” This allows a private citizen with knowledge of the fraud – called a “relator” or whistleblower – to file a lawsuit on behalf of the United States government.
Who can be a whistleblower? Anyone with non-public knowledge of the fraud. This often includes:
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- Current or former employees (doctors, nurses, coders, billing specialists, office managers)
- Hospital administrators
- Pharmaceutical sales representatives
- Competitors who are aware of illegal practices
- Any other insiders with credible information
Whistleblowers in the industry, including doctors, nurses, and contractors, initiate most of the qui tam lawsuits that expose Medicare and Medicaid fraud.
The government relies heavily on courageous whistleblowers. Between 2011 and 2020, lawsuits brought by relators were responsible for 88.5% of the $24.8 billion recovered in FCA judgments and settlements. During the fiscal year ending September 30, 2024, whistleblowers filed 979 qui tam lawsuits, which was the highest number in a single year.
By coming forward, you are not just a whistleblower. You become a critical partner with the government in helping protect American taxpayers.
Understanding whistleblower rewards: Acknowledging your courage
The government understands that speaking up against a powerful company or employer can involve significant personal and professional risk. That is why the False Claims Act provides a substantial potential reward for whistleblowers whose cases lead to the successful recovery of funds.¹
If the government recovers money as a result of your qui tam lawsuit, you may receive up to 30% of the total recovery, which can be a life changing amount.
The exact percentage you may receive depends on several factors, including whether the government decides to intervene and take over the primary prosecution of the case, and the quality of the information and assistance you and your attorneys provide.
Many of the whistleblowers our attorneys have assisted have received millions of dollars for their courage. Even more importantly, they were instrumental in stopping greedy companies from continuing their fraudulent schemes.1,4
Addressing your fears: Whistleblower protections under the FCA
Fear of retaliation is a one of the main reasons people hesitate to report fraud. Potential whistleblowers — especially those who witnessed the fraud at their workplace — may be afraid of losing their jobs, being demoted, or facing professional ruin.
Fortunately, the False Claims Act contains a powerful anti-retaliation provision designed to protect courageous whistleblowers. The law makes it illegal for an employer to fire, demote, suspend, threaten, or harass an employee for taking lawful actions in furtherance of an FCA case.
If an employer violates this provision, you may be entitled to “all relief necessary” to make you whole, which can include:
- Reinstatement to your job
- Double the amount of back pay you lost
- Compensation for litigation costs and attorney’s fees
Proving retaliation can be complex, as some employers may invent other reasons for their actions. This is why having an experienced whistleblower team on your side is critical. We know how to protect you and fight to enforce your rights.
The process: What to expect when you blow the whistle
Navigating a qui tam lawsuit can involve a complex journey. Our team will guide you every step of the way.
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- Free & confidential consultation: It all starts with a phone call. You can speak with a member of our team in complete confidence. We will listen to your story, ask questions, and help you understand if you might have a case.
- Investigation and evidence gathering: If we believe you have a viable claim, our team knows how to work with you to gather evidence and try to build the strongest possible case.
- Filing the lawsuit “under seal:” Your qui tam complaint is filed “under seal” with the court. This means it is kept completely private for at least 60 days. The public cannot see it, and most importantly, the company you are accusing is not notified while it is under seal. This helps protect you from retaliation and gives the government time to investigate.
- The government’s investigation: The U.S. Department of Justice and the U.S. Attorney’s Office will review your complaint and evidence. They will conduct their own investigation, and at the end of their investigation, they will decide whether to “intervene” and take over the case.
- Resolution: If the government intervenes, the case is “unsealed,” and the government prosecutes the case, with you and your attorneys providing assistance. Many cases at this stage are resolved through a settlement. If the government declines to intervene, many legal teams may drop out. Our team has the experience and resources to continue with the case and guide you through the whistleblower process.
Critical first steps (And what to avoid)
What you do next is extremely important. To help protect yourself and the viability of your potential claim, follow these guidelines.
- DO NOT talk to anyone about your suspicions
Do not discuss the fraud with coworkers, friends, or family until you have spoken with an experienced whistleblower attorney. If the people involved in the fraud learn of your suspicions, they may try to destroy evidence or retaliate against you. - DO gather evidence quietly and legally
If you can safely and legally do so, gather documents that support your claim — emails, billing records, internal memos, etc. Do not engage in illegal activity, such as hacking into computer systems, to obtain evidence. Your attorney can advise you on what is appropriate. - DO NOT delay — Time is of the essence
The False Claims Act has a “first-to-file” rule. This means that if another whistleblower files a case based on the same fraud before you do, your claim will likely be barred. Furthermore, strict statutes of limitations (filing deadlines) apply. It is critical to act quickly.
Healthcare whistleblower FAQs
Here are answers to frequently asked questions about healthcare fraud whistleblower cases:
Can I be a whistleblower if I participated in the fraud?
Yes, you can still be a whistleblower – and potentially receive a reward for your efforts – if you participated in the fraud. Many whistleblowers are asked or required to participate in the fraudulent scheme as part of their job. The law is designed to encourage people to come forward, even if they were complicit.
Being transparent with your attorney and the government about your role is crucial. Our team has experience helping people with potential criminal exposure navigate the process and obtain monetary rewards instead of jail time.1,4
How much does it cost to hire a whistleblower attorney?
Our fee structure is designed to benefit you, and you pay nothing upfront and no hourly fees.
We handle whistleblower cases on a contingency fee basis. This means we only get paid a fee if we help you and the government recover money.²
What if the fraud involves a state Medicaid program?
While our primary focus is the federal False Claims Act (which covers federal funds used in state programs like Medicaid), North and South Carolina also have some of their own laws. We can evaluate the specifics of your case to determine the right path forward for you. In our experience, most cases that proceed do so under the powerful federal FCA law.
How long does a qui tam case take?
Since each whistleblower case is unique, the amount of time it takes to resolve one can be anywhere from several months to several years. Whistleblower cases are often marathons, not sprints. And we will be with you for the entire journey.
You have the power to make a difference. Let’s talk.
The fight against healthcare fraud depends on courageous individuals like you. We respect the difficult position you may be in, and we believe it is our duty to provide the experienced, confidential, and steadfast guidance you may need right now.
If you suspect healthcare fraud against the government, you have the power to do something about it. Contact Carolina Whistleblower Attorneys today at 1-888-292-8852 or through our online form for a free and 100% confidential case evaluation. Our experienced team can help you understand your rights and protections under the False Claims Act.
Awards we’ve won
For standards of inclusion for awards listed, visit bestlawyers.com, thenationaltriallawyers.org, superlawyers.com, farrin.com/business-nc-power-list, and millondollaradvocates.com. National Trial Lawyers Top 100 designation is for 2025. Regarding the Million Dollar Advocates Forum, we do not represent that similar results will be achieved in your case. Each case is different and must be evaluated separately. Firm award is for the Law Offices of James Scott Farrin. Attorney awards are for attorneys with the Law Offices of James Scott Farrin.
Contact the Carolina
Whistleblower Attorneys
If you’re wondering if it’s a good idea to speak with a whistleblower lawyer about what you know, let us set the record straight.
- Corporate ethics hotlines can be risky and may lead to termination. If you’ve already done this, call us immediately.
- Your coworkers could be aware of the fraud – or complicit in it – and you should not talk to them about it.
- The first claim to be filed under the False Claims Act can proceed – if you’re not first, you’re at a serious disadvantage and may get nothing (another reason not to speak to your coworkers about it).
- A confidential discussion costs you a few minutes, but could save you time, stress, and money.
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