Acute Care Whistleblower

We Help Caregivers, Billing Personnel, Patients, and Others Blow the Whistle on Acute Care Fraud

In late 2024, the U.S. Department of Health and Human Services’ Office of Inspector General (DHHS OIG) published a report disclosing that Medicare had paid an estimated $190 million in fraudulent acute care claims in five years. This is a substantial amount of fraud that has a direct impact not only on the cost of patient care, but also the quality of patient care in the United States. While the DHHS OIG works to hold health care providers accountable whenever possible, it relies heavily on acute care whistleblowers to shed light on fraud and abuse.

Are you able to serve as an acute care whistleblower?

If you have information about a healthcare provider who submitted false claims or inaccurate claims for acute care, you may be able to come forward as a whistleblower. Under the False Claims Act, whistleblowers who report fraud involving Medicare or Medicaid services, or services under other government healthcare programs, are entitled to confidentiality and protection against retaliation. Whistleblowers who assist the government with recovering fraudulent billings are also entitled to receive a percentage of the taxpayer funds that the government recovers. Our whistleblower lawyers represent caregivers, billing personnel, patients, and other individuals nationwide—and we provide representation at no out-of-pocket cost to our clients.

The U.S. Department of Justice (DOJ) is Targeting Acute Care Fraud

Along with the DHHS OIG, the U.S. Department of Justice (DOJ) also works to hold healthcare providers accountable for all forms of fraud involving federal healthcare programs, including Medicare and Medicaid. Notably, it has specifically targeted acute care fraud in recent years.

For example, in 2024, the DOJ announced a nearly $20 million settlement with a healthcare company charged with various forms of fraud. According to the DOJ’s press release, this specifically included, “allegedly fail[ing] to provide inpatient acute care in accord[ance] with federal . . . regulations, including . . . by failing to provide active treatment, to develop and/or update individualized assessments and treatment plans, to provide adequate discharge planning and to provide required individual and group therapy.”

Then, in 2025, the DOJ announced a $6.5 million settlement in another case focused specifically on acute care fraud. In that case, the DOJ alleged that a skilled nursing facility and acute care hospital were guilty of engaging in fraudulent practices including, but not limited to, attempting to seek reimbursement for medically unnecessary services that Medicare pays based on standardized rates and providing individual outpatient therapy services without a physician’s plan of care.

Both of these cases involved False Claims Act allegations—and they were both the result of complaints filed by whistleblowers who made the decision to come forward.

Do You Have Non-Public Information About Acute Care Fraud?

Deciding whether to serve as an acute care whistleblower begins with understanding if you are eligible to come forward. The primary requirement for serving as a whistleblower under the False Claims Act is that you must have access to non-public information about fraud committed against the federal government (i.e., under Medicare or Medicaid).

In the context of acute care fraud, there are numerous acts and omissions that can justify a whistleblower complaint. Some of the more-common examples of fraud committed by long-term acute care hospitals (LTACH) and other facilities include:

• Billing for acute care services that are not medically necessary 
• Billing for acute care services not actually provided to patients 
• Failing to develop or follow a physician’s care plan 
• Failing to provide active treatment 
• Failing to provide adequate discharge planning or required physical therapy
• Improperly billing Medicare for palliative care for terminal illness or related conditions
• Improperly billing Medicare under the LTACH prospective payments system (LTACH-PPS)
• Failing to repay Medicare for LTACH stays shorter than 25 days 
• Keeping Medicare patients in LTACH facilities longer than medically necessary to influence the average inpatient length of stay and satisfy the 25-day requirement for full payment 
• Transferring patients out of LTACH facilities solely for the purpose of readmission after 25 days

Notably, not only did the DHHS-OIG find that Medicare had paid an estimated $190 million in fraudulent acute care claims, but it also found that 70% of acute care claims showed signs of fraud. In other words, not only can acute care fraud take many different forms, but it is also extremely pervasive. With this in mind, if you have concerns about acute care fraud, you should not ignore them, but instead consult with an experienced whistleblower attorney as soon as possible.

What You Can Expect When You Contact an Acute Care Whistleblower Lawyer at Oberheiden P.C.

Deciding whether you are prepared to serve as a whistleblower isn’t easy. Additionally, for many prospective whistleblowers, this is the first time in their lives that they’ve needed to consult with a lawyer. We understand this, and we focus on making the process as simple, straightforward, and transparent as possible. Here is what you can expect when you contact an acute care whistleblower lawyer at Oberheiden P.C.:

1. Complete Confidence

We will hold all of the information you share with us in complete confidence. This includes your identity. Under no circumstances will we disclose any information you provide to our firm unless you explicitly authorize us to do so.

2. No Out-of-Pocket Costs

We provide our services to whistleblowers (and prospective whistleblowers) at no out-of-pocket cost. This means that your initial consultation is completely free; and, if you decide to blow the whistle, our legal fees (if any) will be paid out of the government’s settlement or judgement if your complaint leads to a successful enforcement action.

3. No Pressure to Move Forward

We will never pressure you to move forward with serving as an acute care whistleblower. This is your decision to make—and you have the right to make it in your own time. When you are contemplating coming forward, our role is simply to provide the advice and information you need to make an informed decision.

4. Personalized and Detailed Advice

We work closely with our clients to provide them with personalized and detailed advice. As a client of Oberheiden P.C., you can expect to work with highly experienced senior lawyers who have the insights required to provide you with custom-tailored representation–whether you work in private practice or for the federal government.

5. Direct Representation and Communication

As a client of Oberheiden P.C., you can also expect to work directly with our senior lawyers throughout your engagement. You will be able to get in touch when you need to; and, if you decide to blow the whistle on acute care fraud (including LTACH fraud), we will communicate directly with the federal government on your behalf.

Put our highly experienced team on your side

Dr. Nick Oberheiden

Founder

Attorney-at-Law

Lynette S. Byrd

Former DOJ Trial Attorney

Partner

Brian J. Kuester

Former U.S. Attorney

Hon. Kevin McCarthy

55th Speaker, U.S. House of Representatives (ret.)

Government Consultant

Mike Pompeo

Of Counsel

Former U.S. Secretary of State

John W. Sellers

Former Senior DOJ Trial Attorney

Linda Julin McNamara

Federal Appeals Attorney

Nicholas B. Johnson

Former Prosecutor

Roger Bach

Former Special Agent (DOJ)

Chris J. Quick

Former Special Agent (FBI & IRS-CI)

Michael S. Koslow

Former Supervisory Special Agent (DOD-OIG)

Ray Yuen

Former Supervisory Special Agent (FBI)

FAQs: Key Insights for Potential Acute Care Whistleblowers