Speaking up for health-care integrity: How the DOJ’s new whistleblower program creates opportunity”

In an era of rising scrutiny on health-care billing, insurance practices, and fraud, whistleblowers have a growing role to play. Not only can raising concerns help protect patients, taxpayers, and the integrity of the health-care system—but today, those who come forward may also see real financial and professional benefits. The DOJ’s new corporate whistleblower award pilot program opens a pathway for insiders in the health-care world to raise misconduct and be rewarded for doing so.
Here’s what you need to know.

What is the program?

In August 2024, the DOJ launched a three-year pilot program called the “Corporate Whistleblower Awards Pilot Program”.
The program is designed to fill in gaps left by other whistleblower mechanisms (for example, those focused on securities, foreign corruption, or the federal False Claims Act).
Among the key focus areas is health-care fraud — especially misconduct involving private insurance or health-care benefit programs not already well covered by other statutes.

In broader terms, the program covers corporate misconduct in these four originally announced areas:

1. Crimes involving financial institutions.
2. Foreign corruption by companies.
3. Domestic corruption involving companies (bribes, kickbacks).
4. Health-care fraud schemes involving private payers or benefit programs outside the typical federal program coverage.

In May 2025, the DOJ expanded the guidance to include broader health-care misconduct — including fraud against patients, investors, and non-governmental entities in health care.

Why this matters for health care

The health-care sector has long been a major focus for fraud-and-abuse enforcement: billing fraud, improper coding, kickbacks, misrepresentation of services, and more. The traditional tool for this has been the federal False Claims Act (FCA), especially for fraud involving Medicare, Medicaid, and other federal benefit programs.
However, many health-care fraud schemes relate to private payers (commercial insurance), or hybrid arrangements, or misconduct against patients rather than purely the government. Such schemes may fall outside the classic FCA “qui tam” relator route. With this new pilot program, whistleblowers now have an alternative path to report misconduct that may not have been covered before.

From a health-care compliance and oversight perspective, that means:

• Private-insurance fraud (and not just Medicare/Medicaid) is now tacitly on the radar.
• Hospitals, insurers, provider networks, medical-coding services, billing companies, and others need to be alert that whistleblowers may emerge from many corners.
• Whistleblower reports may trigger investigations, asset forfeitures, enforcement actions, and therefore heightened risk.

How the program works — and how you can benefit

1. Submitting a tip

A prospective whistleblower submits original, truthful information to DOJ that has not been previously disclosed by other means or covered by another whistleblower award program.
The information must relate to misconduct that ultimately results in a forfeiture (civil or criminal) of assets of at least US$1 million.

2. Evaluation and investigation

DOJ’s Criminal Division (or appropriate division) reviews the tip, consults with investigators and possibly the FBI or other law-enforcement components, and decides whether to open an investigation.
If the investigation leads to a prosecution or resolution resulting in asset forfeiture (or civil forfeiture) and the whistleblower’s information played a meaningful role, then eligibility for award arises.

3. Award determination

If successful, the whistleblower may receive a monetary award which is a percentage of the “net proceeds forfeited.” For example: up to 30% of the first US$100 million in net forfeiture proceeds; and up to 5% of proceeds between US$100 million and US$500 million.
Important caveats:

• The whistleblower must not have “meaningfully participated” in the misconduct (though minimal involvement may still allow eligibility)
• If another existing whistleblower program already covers the misconduct (e.g., FCA qui tam, SEC, CFTC), then eligibility under this DOJ pilot may be barred.
• The award is in DOJ’s sole discretion. Even if criteria are met, the award is not guaranteed.

4. Protections and confidentiality

While the program emphasizes confidentiality of tipsters, whistleblowers should engage legal counsel familiar with whistleblower law. Retaliation protections may apply under other statutes (e.g., other whistleblower laws). For example, the HHS Office of Inspector General (HHS-OIG) has a whistleblower protection coordinator for its domain. Office of Inspector General+1

Benefits to whistleblowers

Here’s what whistleblowers stand to gain:

• Financial reward: If everything aligns, a successful tip could lead to a significant payout (hundreds of thousands or even millions of dollars) depending on the size of the forfeiture.
• Leveraging private-insurer misconduct: Before, much of health-care fraud focused on government payers. Under this program, fraud against private insurers or non-government benefit programs may now qualify. That opens new pathways for those inside private-sector health-care entities.
• Impact and change: Beyond monetary incentives, whistleblowers play a key role in uncovering practices that may harm patients, increase costs, or degrade trust in health-care systems.
• Professional integrity and risk mitigation: By coming forward with credible information, a whistleblower can position themselves on the right side of ethics and compliance rather than staying complicit or passive.

Key considerations and risks

Of course, whistleblowing is not without complexity and risk. Important considerations include:

• Eligibility pitfalls: If the misconduct relates to a program already covered by the FCA who tam route, you might not be eligible for this DOJ program. You’ll need to evaluate which program covers your situation.
• Strong evidence is required: The information must be original, credible, and lead to actionable prosecution/forfeiture. Tips based on public knowledge or “already known” misconduct are less likely to lead to award eligibility.
• Timing and involvement: If you participated in, directed, or benefitted from the wrongdoing, you may be excluded from award eligibility. Also, you should ideally raise concerns internally (if possible) and engage counsel early.
• Retaliation risk: While there are protections, whistleblowers often face workplace retaliation. Understanding your legal rights (state and federal) is important.
• Confidentiality and careful handling: Whistleblowers must handle evidence, disclosures, and counsel communication carefully. A misstep may jeopardize eligibility or confidentiality.
• Not a guarantee: Even if you submit good information, the DOJ may not proceed with prosecution, or decide not to award. You should have realistic expectations.

A roadmap for potential whistleblowers in health-care

If you work in a hospital, insurance payer, billing company, medical-coding vendor, provider network, or related health-care organization and you suspect wrongdoing, you might follow this general path:

1. Document credible evidence of misconduct (billing for services not performed, upcoding, kickbacks, false claims to private insurers, fraud against patients, etc.).
2. Consult with a qualified attorney experienced in whistleblower law and health-care compliance.
3. Consider internal reporting (if you’re able and safe), while preserving documentation of the wrongdoing and your communications.
4. Evaluate whether the misconduct might fall under this DOJ pilot program (especially if it involves private insurers or non-government benefit programs) or other whistleblower statutes (FCA, SEC, etc.).
5. Prepare to submit your tip to DOJ: use the intake mechanism (e.g., CorporateWhistleblower@usdoj.gov) as outlined in the program guidance.
6. Protect yourself from retaliation: know your legal rights, communicate with counsel, and preserve evidence.
7. Be patient: these investigations may take time, especially for asset forfeiture outcomes and award determinations.
8. Stay confidential and follow counsel’s guidance to maintain eligibility for award and protection.

Conclusion

The DOJ’s Corporate Whistleblower Awards Pilot Program marks a significant shift for health-care and private-payer fraud enforcement. For whistleblowers in the health-care arena, this is a moment to pay particular attention: your insider perspective and knowledge can trigger investigations, protect patients and taxpayers, and potentially lead to significant rewards. At the same time, the path is complex and requires careful navigation with legal counsel, strong evidence, and strategic handling.

If you’re considering stepping forward—or advising someone who is—it’s worth investing time to understand the rules, evaluate eligibility, and prepare thoughtfully.

Here are several recent outcomes in health-care whistleblower / fraud cases from the Department of Justice (DOJ) / False Claims Act (FCA) space, plus commentary to give you an idea of the scale and how whistleblowers benefit.

✅ Selected Payment Outcomes

1. Walgreens Boots Alliance
   • The company agreed to pay US$106.8 million to resolve allegations of submitting false claims to federal health-care programs (Medicare/Medicaid) for prescriptions processed but never picked up.
   • Two whistleblowers were awarded approximately US$14.9 million and US$1.6 million respectively for their role. Wall Street Journal
   • This shows that even in larger health-care provider/retailer cases, relators (whistleblowers) may receive multi-million dollar awards.
2. Christiana Care Health System (Delaware hospital system)
   • Settled for more than US$47 million to resolve allegations of providing kickbacks to physicians for referrals, leading to improper Medicaid billing. AP News
   • The whistleblower (a former compliance officer) reportedly received around US$12 million of that. AP News
   • Example of health-care provider fraud (kickbacks / referrals) being resolved and whistleblower rewarded.
3. Sector-wide recovery for Fiscal Year 2024
   • DOJ reports: Settlements & judgments under the False Claims Act exceeded US$2.9 billion in FY 2024.
   • Of that, more than US$1.67 billion related to matters involving the health-care industry (managed care, hospitals, labs, pharmacies) in FY 2024.
   • Whistleblowers in those FCA actions helped drive approx. US$2.4 billion of the recoveries in 2024.
   • These numbers help show the potential scale of recoveries and the corresponding scale of possible awards (though individual award amounts depend heavily on case specifics).
4. A more recent case: Omnicare Inc. (a unit of CVS Health Corporation)
   • A federal judge ordered Omnicare (through CVS’s ownership) to pay US$948.8 million in penalties and damages in a whistleblower case involving allegedly invalid prescription billing in long-term care facilities. Reuters
   • While the exact whistleblower share isn’t publicly detailed yet, one source suggests the whistleblower’s reward could top US$142 million.
   • Illustrates a large FCA recovery in the health-care context, signalling that big-scale awards may be possible where the recoveries are massive.
5. Smaller / illustrative example: Biotronik Inc.
   • Settlement: US$12.95 million against the company. Whistleblower Network News
   • Whistleblowers awarded collectively US$1.25 million (split among two relators and counsel) in that case. Whistleblower Network News
   • This demonstrates that even “mid-size” health care fraud cases yield meaningful awards for whistleblowers.

Key Takeaways for Whistleblowers

• Scale matters: The larger the recovery/settlement (or potential forfeiture), the greater the potential award for the whistleblower. But large recoveries also mean significant investigations, resources, and time.
• Whistleblower share varies: In the examples above, we see awards ranging from low millions (US$1-15 m) to potential tens or hundreds of millions (depending on the recovery). The percentage is influenced by factors like the whistleblower’s contribution, timing of filing, uniqueness of information, government intervention, etc.
• Timing & originality count: Relators who bring original, non-public information and whose filings lead to government intervention tend to fare better. Also, being first-to-file can be advantageous.
• Industry context matters: Health-care remains one of the biggest areas for FCA recoveries, so whistleblowers in this field may have increased opportunity.
• Not guaranteed: Even with large recoveries, actual whistleblower awards depend on many variables and are at the DOJ’s discretion (or the relevant agency’s rules).
• Legal counsel is critical: Because the process is complex—documenting fraud, handling confidentiality, knowing eligibility rules—whistleblowers should seek experienced counsel.

Matthew Galluzzo is a former Manhattan prosecutor who represents whistleblowers in federal and state litigation. If you have information that you believe could lead to a meritorious investigation of health fraud against the government, you should strongly consider contacting Matthew Galluzzo to determine whether you might be able to earn an award through the Department of Justice’s health care whistleblower program.