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ADOLPHUS LAW False Claims Act
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False Claims Act and government fraud

Fraud is under-enforced.

We compare public claims, provider, ownership and court records to find billing patterns no single claim reveals. Then we test whether the pattern can be proved under the False Claims Act.

Report suspected fraud How a qui tam case works
Two cents in one hundred dollars Ten thousand marks represent one hundred dollars of HHS spending, expressed in cents. Two marks are highlighted, representing the roughly two cents per one hundred dollars that HHS OIG's fiscal year 2023 budget of $432.5 million represented. Two cents of one hundred dollars
2¢per $100 of HHS spending4 Source 4, see sources page
The problem

HHS OIG oversaw more than $2 trillion with roughly 2¢ for every $100 spent.

That gap is why insiders matter. They know which ordinary-looking claims do not match what happened.

Read the analysis
The signal

When enforcement moved, the claims moved.

After a 2019 orthotic-brace enforcement action, fee-for-service claims fell 9 percent while Medicare Advantage claims rose 22 percent within weeks.

A shift like that is not proof of fraud. It is a question that can be tested against providers, ownership, billing history and what happened on the ground.

Read the method
Claims migrate after enforcement After a 2019 enforcement action against an orthotic brace scheme, Medicare fee-for-service claims for those braces fell 9 percent, while claims for the same braces billed to Medicare Advantage rose 22 percent within weeks. +22% Medicare Advantage -9% Fee-for-service Before Weeks later 0
After a 2019 enforcement action against an orthotic brace scheme, Medicare fee-for-service claims for those braces fell 9 percent. Claims for the same braces billed to Medicare Advantage rose 22 percent, not years later but weeks later.4 Source 4, see sources page
For relators

An insider can explain what the claims leave out.

Employees, clinicians, contractors, analysts, and competitors often see one part of a scheme. Data can show whether that part belongs to something larger.

A qui tam case lets a private person bring evidence on behalf of the United States. The claim still has to satisfy the statute and survive the innocent explanation.

If you have direct knowledge, records, or a pattern that does not make sense, we want to understand it.

Speak with a lawyer How a qui tam case works
Qui tam share of False Claims Act recoveries Of $85.65 billion in False Claims Act settlements and judgments from fiscal year 1987 through fiscal year 2025, $60.97 billion came from qui tam matters brought by private relators. $60.97B Brought by relators under the qui tam provisions $85.65B All FCA recoveries, FY1987-FY2025
Of $85.65 billion in False Claims Act settlements and judgments reported by the Department of Justice for FY1987 through FY2025, $60.97 billion came from qui tam matters brought by private relators.3 Source 3, see sources page
Next step

Tell us what happened.

What you saw. When you saw it. Which government program paid. Why the billing did not match the work.

Contact Adolphus Law

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