Whistleblower Practice

Medicare Advantage and Medicaid managed-care plans operated by private insurers like UnitedHealth, Cigna, and Elevance cover more beneficiaries than the traditional Medicare and Medicaid programs.

These insurers receive hundreds of billions of dollars each year in government funds. But as fraud cases and congressional investigations show, the insurers often seek to boost their profits at the public’s expense, including by inflating risk scores, denying necessary care, skimping on compliance, and using kickbacks and other improper marketing tactics to cherry-pick enrollees.

BLB&G’s deep experience in managed-care fraud cases and our in-house data analysis capabilities can help whistleblowers develop powerful cases. We work closely with the U.S. Department of Justice and state attorney general offices to secure recoveries and protect whistleblowers from retaliation.

Representative Cases

$172 Million Settlement with Cigna Group for Alleged Coding Fraud

False Claims Act Lawsuit Against Anthem for Alleged Coding Fraud

$90 Million Settlement with Sutter Health Hospitals for Alleged Submissions of False Diagnosis Information to Medicare Advantage Plans

In 2024, prescription drug spending in the United States exceeded $700 billion. To maximize sales of their products, some drug manufacturers have given kickbacks to doctors, hospitals, and pharmacies, offered improper co-pay waivers to patients, promoted their drugs contrary to FDA guidelines, and engaged in unlawful drug pricing schemes.

With our experience litigating drug marketing fraud cases and our expert in-house investigators, BLB&G can help whistleblowers corroborate and validate their concerns and build cases that align with government enforcement priorities.

DME is equipment that can be used repeatedly, such as at-home ventilators, back braces, glucose monitors, hearing aids, and electric wheelchairs. Government analysis has shown that one-third of Medicare payments for DME items were improper because the items were unnecessary. DME suppliers often bill for those unnecessary items using kickbacks and by falsifying medical records.

For whistleblowers with information on DME fraud, BLB&G will leverage our knowledge, data analysis capability, and investigative muscle to stop the fraud and obtain recovery.

As tariffs become a key part of America’s industrial policy, there will be increasing incentives for companies to try to underpay customs duties to gain competitive advantage and boost profits. This can involve double invoicing (underreporting the value of imported goods to U.S. Customs and Border Protection), misclassification, or falsifying the countries of origin through trans-shipments.

For companies and individuals with information about suspected customs evasion, BLB&G will apply our data analysis and investigative capabilities to help uncover the fraud, develop the evidence, and obtain a recovery.

We assist insiders, analysts, and other market participants who uncover violations such as accounting misstatements, insider trading, market manipulation, hidden fees, or crypto‑asset schemes. Our team will prepare incisive submissions to the U.S. Securities and Exchange Commission and Commodity Futures Trading Commission and work with the enforcement staff at those agencies to secure significant monetary awards.