In May 2025, the U.S. Department of Justice (DOJ) revised its Corporate Whistleblower Awards Pilot Program targeting corporate misconduct, with a strong emphasis on health care fraud. This program opens new doors for whistleblowers to come forward, report wrongdoing, and receive financial compensation. For individuals in Southwest Virginia who suspect fraud in the health care industry, understanding how this program works and interacts with existing laws like the False Claims Act is crucial.
What is the False Claims Act?
The False Claims Act, commonly referred to as the FCA, is one of the federal government’s most powerful legal tools for fighting fraud against taxpayer-funded programs like Medicare, Medicaid, TRICARE, and other health care benefit programs that are widespread in the Roanoke Valley and much of the country. Under the FCA, private citizens—called relators—can file qui tam lawsuits on behalf of the federal government if they have credible evidence of fraud. Fraud in the health care industry includes things like billing for services not rendered, upcoding, kickbacks, medically unnecessary procedures, and fraudulent cost reports.
In these types of cases, the lawsuit is brought by the relator but in the name of the federal government. Once filed, the federal government can choose to intervene or not intervene—that is, choose whether they want to be involved in prosecuting the case. If the federal government intervenes, whistleblowers are entitled to 15-25% of the recovered funds. If the federal government declines and the relator continues the case independently, the reward increases to 25-30%. But despite the lesser award, it can be a good sign when the federal government intervenes: that likely means it is a case of significant value.
The FCA also protects whistleblowers from employer retaliation, including demotion, harassment, or termination. This is an independent claim, distinct from the relator claim brought on behalf of the federal government. It is based on the damages suffered by the relator, not the federal government. These damages can be extensive, but include reinstatement; double the amount of back pay; interest on the back pay; and compensation for any special damages sustained as a result of the retaliation, including litigation costs and reasonable attorneys’ fees.
The DOJ’s Corporate Whistleblower Awards Pilot Program
The DOJ’s Corporate Whistleblower Awards Pilot Program was launched in August 2024, but revised recently by the new administration in May 2025. This is a separate—but complementary—tool to encourage tips about corporate wrongdoing. The program is particularly focused on federal health care offenses, such as kickbacks, illegal billing, and false certifications, and fraud targeting non-government victims, including investors and patients, in the health care sector.
The Corporate Whistleblower Awards Pilot Program differs from the FCA in several ways.
First, unlike the FCA, a whistleblower does not need to file a lawsuit. They can simply provide a high-quality, original tip to the DOJ or the FBI. This allows whistleblowers to remain anonymous, especially if represented by an attorney. Of course, before the DOJ will pay any award, the whistleblower must disclose their identity to the DOJ, and their identity must be verified by the DOJ. However, this is a significant difference from FCA claims, which generally require relators to identify themselves in court documents which, eventually, become public.
Second, awards from the Corporate Whistleblower Awards Pilot Program are discretionary, based on the value of the tip and the success of the investigation. If the DOJ successfully obtains a forfeiture based on the tip, the whistleblower(s) may obtain up to 30% of the first $100,000,000.00 in net proceeds and up to 5% of any net proceeds between $100,000,000.00 and $500,000,000.00. If the DOJ finds that an award is appropriate, there is a presumption that the whistleblower will receive 30% of the first $10,000,000.00 in net proceeds, that is, $3,000,000.00.
On the other hand, factors such as the whistleblower’s culpability, delay, interference, and oversight over the fraud can reduce the value of the award, and eliminate the presumption noted above. This is in contrast to the FCA’s fixed percentage structure, which awards the relator a minimum value in all cases where the federal government is successful.
Third, the Corporate Whistleblower Awards Pilot Program covers violations committed by or through companies related to (a) federal health care offenses and related crimes involving health care benefit programs, and (b) fraud against patients, investors, and other non-governmental entities in the health care industry. Thus, whereas the FCA only addresses fraud against the federal government, the Corporate Whistleblower Awards Pilot Program covers a wider array of conduct.
The DOJ has stated that the Corporate Whistleblower Awards Pilot Program will prioritize timely, credible, and actionable tips. It aims to fill gaps where the FCA may not apply—particularly when fraud does not directly harm a government program.
FCA vs. Pilot Program: Which Route Is Better?
Whether to file under the FCA or submit information through the DOJ’s Corporate Whistleblower Awards Pilot Program depends on the nature of the fraud and your goals as a whistleblower. In many cases, especially where federal health care dollars are involved, pursuing an FCA case may yield a higher, more predictable financial reward. Government intervention is a good signal that the case has merit and may result in a substantial payout. However, if the fraud affects private investors or patients but not the government, the Corporate Whistleblower Awards Pilot Program may be the only viable avenue.
Both the FCA and the Corporate Whistleblower Awards Pilot Program are complex, high-stakes legal channels. That is why if you are a potential whistleblower of health care fraud, an attorney can help you assess whether your case qualifies under the FCA, the Corporate Whistleblower Awards Pilot Program, or both. An attorney can also help you report fraud anonymously and navigate confidentiality protections; ensure your evidence is credible, organized, and presented in a way that compels DOJ action; and explore whether you have been retaliated against in violation of the FCA and what legal avenues you might have to pursue a retaliation claim.
Are You Aware of Corporate Health Care Fraud? Contact Fishwick & Associates to Discuss Your Legal Options
The DOJ’s revised Corporate Whistleblower Awards Pilot Program offers a new incentive for individuals to report corporate wrongdoing, particularly in the health care industry. When used alongside the False Claims Act, it provides whistleblowers with multiple avenues to expose fraud and receive compensation.
However, choosing the right path is not a decision that should be made lightly or alone. If you suspect health care fraud, consult with a law firm experienced in Qui Tam, FCA, and DOJ whistleblower programs like Fishwick & Associates. Our team is dedicated to providing comprehensive legal support to whistleblowers in the Roanoke Valley and throughout Virginia. To schedule your confidential consultation, complete our online contact form or call us at 540-345-5890.
References
31 U.S.C. § 3729–3733