Healthcare Whistleblower Protection Act

Learn What Healthcare Workers and Federal Workers Need to Know About Blowing the Whistle on Healthcare Fraud

While there are several federal whistleblower protection laws, there isn’t a specific “Healthcare Whistleblower Protection Act.” Instead, healthcare workers and federal employees who are prepared to come forward with information about healthcare fraud must do so under one of the federal laws that protect whistleblowers more broadly.

But, while there might not be a federal statute that applies specifically to healthcare whistleblowers, combating healthcare fraud is among the federal government’s top law enforcement priorities. The U.S. Department of Justice (DOJ) and other federal agencies rely heavily on whistleblowers to come forward, and healthcare whistleblowers will be entitled to both stringent protections and substantial monetary rewards in many cases.

Federal Laws that Protect Whistleblowers in Healthcare Fraud Cases

There are two federal laws that apply in the vast majority of healthcare whistleblower cases. These are: (i) the federal False Claims Act (FCA); and, (ii) the federal Whistleblower Protection Act (WPA). Both of these laws protect whistleblowers who report fraudulent practices resulting in the loss of federal funds under Medicare, Medicaid, and other healthcare benefit programs:

The False Claims Act (FCA): Current and Former Employees of Healthcare Providers and Other Industry Participants

The federal False Claims Act (FCA) prohibits healthcare providers, federal contractors, and other entities from submitting “false or fraudulent claims” for payment to the federal government. In the federally funded healthcare sector, this includes (but is by no means limited to) fraudulent billing practices such as:

• Billing for medically unnecessary services
• Overbilling
• Double billing
• Paying and receiving illegal kickbacks
• Phantom billing
• Unbundling
• Upcoding

Current and former healthcare employees can report these (and other) forms of alleged wrongdoing to the federal government by filing a qui tam lawsuit under the False Claims Act in federal court. Individuals in the private sector can also report numerous other forms of Medicare and Medicaid fraud, as well as fraud in federally funded scientific research and grant programs.

Whistleblower Protections Under the FCA

Under the FCA, private-sector employers are prohibited from taking adverse employment action against healthcare whistleblowers based on their decision to come forward, and whistleblowers can file retaliation claims when necessary.

With that said, while the FCA prohibits retaliation, it also provides stringent protections for whistleblowers’ identities. As a result, healthcare whistleblowers’ identities will remain confidential in most cases. When we come forward on a current employee’s behalf, we work with the government to help ensure that our client’s identity remains protected by all means available.

Whistleblower Rewards Under the FCA

When eligible healthcare whistleblowers help the federal government recover taxpayer funds under the False Claims Act, they are entitled to a monetary reward calculated as a percentage of the funds recovered. Healthcare whistleblower rewards under the False Claims Act can range from 15% to 30% of the government’s recovery.

The Whistleblower Protection Act (WPA): Current and Former Employees of the Federal Government

The Whistleblower Protection Act (WPA), as amended by the Whistleblower Protection Enhancement Act (WPEA), applies to current and former federal employees who report fraud under federal programs, substantial and specific dangers to public health or safety, gross mismanagement, gross waste, and other forms of fraud, waste, and abuse (FWA). The WPA and WPEA also provide stringent confidentiality and whistleblower retaliation protections; and, while they do not include reward provisions, rewards may still be available in some cases.

In many situations, coming forward will involve working with the U.S. Department of Health and Human Services’ Office of Inspector General (DHHS OIG). However, this is not the only option, and federal employees must ensure that they come forward through the correct channels in order to make a protected disclosure. We represent current and former federal employees in healthcare whistleblower cases as well, and our attorneys can help you expose a violation of any federal law, rule, or regulation to the appropriate department, office, or agency.

5 Key Considerations for All Prospective Healthcare Whistleblowers

In all cases, there are some key considerations that prospective healthcare whistleblowers will want to keep in mind. For example:

1. Original Information

Generally, to qualify as a whistleblower, an individual must be prepared to disclose “original information” that is not currently known to the federal government. The FCA and WPA both protect workers who make such disclosures through the appropriate channels. When whistleblowers make qualifying disclosures to the appropriate authorities, blowing the whistle constitutes a “protected activity” under federal anti-retaliation laws (including, but not limited to, the FCA and WPA).

2. Authorized Recipients

All whistleblowers must disclose their original information to authorized recipients. In False Claims Act cases, this involves filing a lawsuit in federal court, as noted above. However, for federal employees, authorized recipients may include:

• Congressional committees
• The DOJ or another federal law enforcement agency
• The Government Accountability Office (GAO)
• The Office of Special Counsel (OSC)
• A designated agency official

While whistleblowers can contact non-governmental audiences in limited circumstances, this can be risky—and, as a result, it isn’t recommended as a first course of action in most cases. Due to the stringent requirements for securing whistleblower protection (and establishing whistleblower reward eligibility), we strongly recommend that private-sector employees, DHHS employees, and other individuals consult with an experienced healthcare whistleblower attorney before attempting to come forward.

3. Whistleblower Protections

The FCA and WPA both provide strong confidentiality protections for whistleblowers. They also both prohibit whistleblowers’ employers from taking disciplinary action or other adverse action based on a whistleblower’s decision to come forward. As discussed above, our attorneys will work with the federal government to protect your identity; and, while retaliation is unlikely, we will be prepared to take legal action against your employer on your behalf if warranted.

4. Whistleblower Rewards

As discussed above, individuals who file successful whistleblower claims under the False Claims Act are generally entitled to a reward calculated as between 15% and 30% of the federal funds recovered. While federal employees generally are not eligible to claim whistleblower rewards under the FCA, the OSC announced a new policy in 2025 that, “encourage[es] agencies to provide monetary rewards in some cases to federal employees who blow the whistle and successfully uncover wrongdoing within [the] federal government.”

5. Legal Representation

As a prospective healthcare whistleblower, it is critical to ensure that you are making informed decisions. This starts with engaging experienced legal representation. We represent all of our whistleblower clients at no out-of-pocket cost. We will not charge you anything to help you make an informed decision about coming forward; and, if you decide to come forward, our legal fees (if any) will be calculated as a percentage of the amount we help you recover.

FAQs: Exposing Fraud, Waste, and Abuse in the Healthcare Industry

Speak with a Senior Health Care Fraud Whistleblower Attorney at Oberheiden P.C. in Strict Confidence

If you would like to speak with an attorney about serving as a healthcare whistleblower, contact us today. Call 866-320-3959 or contact us confidentially online to arrange a free and confidential consultation as soon as possible.