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Category Archives: Whistleblowers

July 11

Nursing Home Fraud Settlement: Cheltenham Rehab to Pay $3.6M for Substandard Care

On June 3, 2025, the Department of Justice (DOJ) announced that the American Health Foundation (AHF), its affiliate AHF Management Corporation, and three affiliated nursing homes, including Cheltenham Nursing & Rehabilitation Center (Cheltenham), have agreed to pay $3.61 million to resolve a False Claims Act case brought by the United States of America. The complaint alleges that AHF defrauded Medicare and Medicaid by billing for non-existent or grossly substandard care.…

July 10

FCA Qui Tam, Whistleblowers

New York Medicaid Fraud: AG James Nets $13M from Fake Medical Transportation Billing

On June 30, 2025, New York Attorney General (NYAG) Letitia James announced that her office successfully investigated 25 transportation companies for billing Medicaid for fraudulent trips, such as nonexistent rides, inflated mileage, and illegal patient kickbacks, securing over $13 million in settlements. How Transportation Companies Committed Billing Fraud Millions of New Yorkers rely on Medicaid and Medicaid-covered services, including transportation to and from healthcare facilities. Unfortunately, some companies have taken…

July 03

Whistleblowers, FCA Qui Tam

DOJ Secures Sentences in $30 Million COVID-19 Unemployment Fraud Scheme

On May 23, 2025, the Department of Justice (“DOJ”) announced that three co-conspirators were sentenced to up to 15 years in prison and ordered to pay restitution after being found guilty of defrauding the Georgia Department of Labor (“GDOL”) of more than $30 million in a COVID-era scheme. Macovian Doston, Shatara Hubbard, and Torella Wynn fraudulently submitted over 5,000 unemployment insurance (“UI”) claims, taking advantage of UI programs expanded through…

July 02

FCA Qui Tam, Whistleblowers

$9.2 Million Healthcare Kickback Settlement Highlights Ongoing FCA Enforcement

A recent $9.2 million settlement by hospice company Creative Hospice Care, Inc. Illustrates the power of the False Claims Act (“FCA”) in combating healthcare fraud. In 2024, the Department of Health and Human Services collected recoveries totaling $1.67 billion from FCA cases. How does the Anti-Kickback Statute intersect with False Claims Act enforcement? The False Claims Act (“FCA”), 31 U.S.C. § 3729, et seq., is a civil war era statute…

July 01

FCA Qui Tam, Whistleblowers

HHS–OIG Flags $16.6 B in Healthcare Fraud in the Spring 2025 Semiannual Report to Congress

The Department of Health & Human Services (“HHS”) Office of Inspector General (“OIG”) is responsible for overseeing the department and promoting and maintaining the efficiency, effectiveness, and integrity of its programs. On June 2, 2025, HHS-OIG released its Spring 2025 Semiannual Report to Congress, summarizing HHS activities for the 6-month period between October 1, 2024, and March 31, 2025. The Spring 2025 Report (the “Report”) identified more than $16.6 billion…

June 27

Firm News, FCA Qui Tam, Whistleblowers

Federal Judge Finds PBM Caremark Liable for $95 Million in Generic Drug Overcharges to U.S. Government

PHILADELPHIA, June 27, 2025 -- Miller Shah LLP and Berger Montague PC, on behalf of their whistleblower client, are pleased to announce that on June 25, 2025, a Pennsylvania federal judge found pharmacy benefits manager Caremark and related entities liable for overcharging the government by $95 million for generic drugs provided to Medicare beneficiaries. The case was initially filed in 2014 pursuant to the False Claims Act, which allows private citizen whistleblowers to bring claims on…

June 26

Whistleblowers, FCA Qui Tam

Senators Call for IRS Whistleblower Reforms to Help Catch Major Tax Fraud

Overview In 2006, the Internal Revenue Service (“IRS”) established their Whistleblower Program. The program aims to diminish tax fraud by empowering individuals to come forward and report this potential fraud within their organizations. The program is structured to protect these individuals, or tax fraud whistleblowers, from retaliation, and provide compensational rewards for their contributions if their whistleblowing does lead to the discovery of tax fraud. Since its inception, the program…

June 20

FCA Qui Tam, Whistleblowers

DOJ Files Major Medicare Fraud Lawsuit Against National Health Insurers

Kickback Allegations Against Major Insurers and Brokers On May 1, 2025, the United States filed a False Claims Act (“FCA”), 31 U.S.C. § 3729 et seq., lawsuit against Aetna, Elevance Health (formerly known as Anthem), and Humana – three of the largest insurance companies in the country – as well as eHealth, GoHealth, and SelectQuote – three of the largest insurance broker organizations in the country. The Medicare fraud lawsuit…

June 13

Whistleblowers

Climate Change Lawsuit Against Oil Companies Clears Legal Hurdle, Signals New Era of Accountability

First-of-its-kind wrongful death suit filed against ExxonMobil, BP, and Chevron, and other oil companies for their involvement in climate change The 2021 Pacific Northwest heat dome was a period of extreme heat that saw temperatures averaging around 121.3 F across British Columbia, Oregon, and Washington state and resulted in an estimated 1,400 deaths, making it the hottest and deadliest heatwave that the Pacific Northwest has ever experienced. A civil lawsuit…

June 12

Whistleblowers

Congress Introduces AI Whistleblower Protection Act to Address Emerging Tech Risks

On May 15, 2025, Senate Judiciary Committee Chair Chuck Grassley (R-Iowa) introduced the Artificial Intelligence (AI) Whistleblower Protection Act with the objective of safeguarding tech employees and whistleblowers in the AI sector. From restrictive severance offers to mandatory non-disclosure agreements, workers in the AI space currently face a myriad of challenges discouraging them from disclosing critical information on working conditions, tech vulnerabilities, and security concerns to the federal government and…

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