Expanded Whistleblower Rewards Program Targets Healthcare Fraud

The U.S. Department of Justice (DOJ) has announced a new strategy to combat white-collar crime with a sharp focus on Medicare, Medicaid, and healthcare fraud, unveiling expanded financial incentives for whistleblowers who expose misconduct.

A memorandum issued by the DOJ’s Criminal Division laid out enforcement priorities, emphasizing that fraud targeting government healthcare programs remains “first on the list” of threats to be addressed. Officials warned that fraudulent schemes drain taxpayer resources and harm vulnerable patients, making healthcare fraud a top criminal and civil enforcement target.

“Healthcare fraud continues to account for the majority of our False Claims Act recoveries,” the memo noted, pointing to $1.67 billion—nearly 60% of all federal FCA recoveries—in fiscal year 2024 alone.

Whistleblower Rewards Expanded

As part of its crackdown, DOJ is broadening its Corporate Whistleblower Awards Pilot Program, first introduced in August 2024. The revised program offers significant payouts to individuals who provide original, non-public information leading to successful prosecutions of corporate crime, including healthcare-related offenses.

Under the program, whistleblowers may receive:

Up to 30% of forfeitures between $1 million and $100 million;

Up to 5% of forfeitures between $100 million and $500 million.

Unlike the civil False Claims Act—which allows whistleblowers to sue on the government’s behalf and recover between 15% and 30% of damages—the Pilot Program applies strictly to criminal cases. However, DOJ is encouraging whistleblowers to submit information to multiple programs if they are unsure where their claims may fit.

The Pilot Program also covers fraud not traditionally reached by the False Claims Act or Anti-Kickback Statute, including fraud against private health insurers, the Federal Employee Health Benefit Program (FEHBP), and violations of the Eliminating Kickbacks in Recovery Act of 2018.

The False Claims Act remains the gold standard for filing a whistleblower case because (a) it imposes civil liability based on a lower standard of proof than in a criminal action; and (b) the financial rewards for the whistleblower are potentially much higher.  False Claims Act damages include three times the actual damages, plus penalties ranging roughly from $13,000 to $28,000 per claim (as of 2025).  

If a whistleblower has a case that could be eligible for both the Pilot Program and the FCA and could choose only one, they would generally be better off with the FCA.  There, the reward is guaranteed to be at least 15% of the amount the government actually recovers and up to 30% if the government declines and the whistleblower proceeds to recovery on their own.

“The message is clear,” the DOJ memo concluded. “We will reward those who come forward with credible information, and we will hold accountable those who exploit our healthcare system for profit.”

If you have evidence that a healthcare provider is submitting false claims to Medicare, Medicaid, or another form of health insurance, you should contact an experienced whistleblower lawyer immediately to protect your rights to a substantial financial reward and legal protections.  Call John Howley, Esq. today at 212-601-2728 to schedule a free and confidential consultation.