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Overview
Fighting Healthcare Fraud and Government Contract Abuse in Illinois
Healthcare fraud costs Illinois taxpayers billions annually, draining resources from legitimate medical care and essential government services. Chicago stands at the epicenter of major healthcare fraud enforcement, with the Northern District of Illinois prosecuting some of the nation’s largest False Claims Act cases. Recent settlements include nearly $2 million from a Chicago healthcare company for upcoding fraud, over $750,000 from a suburban Chicago doctor for unbundling procedures, and a $25 million judgment against a healthcare provider for false care plan oversight claims. These recoveries demonstrate the critical role whistleblowers play in exposing fraud against Medicare, Medicaid, and other government programs.
Illinois provides powerful tools for whistleblowers through both federal and state False Claims Acts. The Illinois False Claims Act covers claims where the state provides any portion of funds, including state agencies, universities, school districts, and municipalities. Chicago has its own False Claims Act providing additional protections. These overlapping laws create comprehensive coverage for exposing fraud while offering substantial financial rewards, typically 15-30 percent of recoveries,for those brave enough to come forward with evidence of wrongdoing.
Paul Padda Law’s Chicago qui tam whistleblower attorneys understand the complexities of False Claims Act litigation in the Northern District of Illinois. We guide whistleblowers through the sealed filing process, work with government investigators during intervention decisions, and aggressively pursue cases when the government declines. Our comprehensive approach protects your identity while maximizing potential recovery through strategic prosecution of healthcare fraud, government contract fraud, and other schemes defrauding taxpayers.
Don’t let fraud against the government continue. Contact Paul Padda Law at (312) 702-7000 or through our online form for a confidential consultation about your whistleblower case.
Understanding Qui Tam Actions Under Federal and Illinois Law
“Qui tam” derives from the Latin phrase meaning “who sues on behalf of the king as well as for himself.” This ancient concept empowers private citizens to act as private Attorneys General, exposing fraud the government might never discover independently.
The False Claims Act Framework:
Federal False Claims Act: Passed during the Civil War to combat defense contractor fraud, the False Claims Act remains the government’s primary anti-fraud tool. In FY2024, over $2.9billion was recovered due to fraud, waste, and abuse in the industry. Key provisions include:
● Triple damages plus penalties of $13,946 to $28,619 per false claim (as of 2025)
● Whistleblower rewards of 15-25 percent if government intervenes, 25-30 percent if proceeding alone
● Protection against retaliation
● Six-year statute of limitations (up to 10 years with discovery rule)
Illinois False Claims Act (740 ILCS 175): The Illinois False Claims Act covers fraud against state and local government entities. Like the federal FCA, the Illinois False Claims Act does not cover claims, records, or statements made under the Illinois Income Tax Act. Key features:
● Coverage for all state-funded programs
● Penalties of $5,500 to $11,000 per false claim plus triple damages
● Whistleblower rewards of 15-30 percent of recovery
● Protection for municipalities, school districts, counties
● Coordination with federal cases for Medicaid fraud
Northern District of Illinois Enforcement:
Chicago’s federal prosecutors aggressively pursue healthcare fraud through:
● Newly created Healthcare Fraud Section
● Coordinated federal-state investigations
● Record-breaking enforcement actions
● Multi-million-dollar settlements
Recent Northern District cases demonstrate enforcement priorities:
● KareFirst Management: $2 million for proprietary software causing upcoded claims
● Cancer Therapy Associates: $757,879 for unbundling mole removal procedures
● Docs at the Door: $25 million judgment for false care plan oversight claims
Common Types of Healthcare Fraud in Chicago
Healthcare fraud remains the most common False Claims Act violation, with schemes evolving to exploit new programs and technologies.
Medicare and Medicaid Fraud:
Upcoding: Billing for more expensive services than provided:
● Telephone consultations billed as in-person visits
● Routine care billed as complex procedures
● Nurse services billed as physician care
● Standard equipment billed as specialized devices
Unbundling: As part of a settlement agreement approved by U.S. District Chief Judge Rebecca R. Pallmeyer, Greager and CTA agreed to pay $757,879.90 for performing multiple mole removal procedures on patients on a single date but submitting claims that made it appear as though the procedures had been performed on multiple dates.
Double Billing:
● Submitting same claim to multiple insurers
● Billing both Medicare and secondary insurance improperly
● Duplicate claims for single service
● Billing patient and insurance for same service
Skilled Nursing Facility Fraud:
Chicago-area nursing facilities frequently engage in:
● False care plan oversight claims
● Phantom billing for services never provided
● Kickbacks for patient referrals
● Unnecessary therapy services
● Improper use of nurse practitioners
COVID-19 Related Fraud:
ANOSH AHMED and others were indicted for their roles in an alleged $894 million fraudulent Covid-19 testing scheme, causing laboratories to submit false claims to the HRSA Covid-19 Uninsured Program.
Common COVID schemes include:
● False testing claims
● PPP loan fraud
● Vaccine administration fraud
● Personal protective equipment price gouging
Prescription Drug and DME Fraud:
● Kickbacks for prescriptions
● Off-label marketing schemes
● Best Price fraud affecting Medicaid reimbursement
● Unnecessary durable medical equipment
● Compounded medication schemes
Building Your Qui Tam Case
Successful whistleblower cases require specific evidence and strategic presentation to interested government prosecutors.
Essential Elements to Prove:
To successfully bring a False Claims Act claim, you must show:
● False statement or fraudulent conduct
● Made with knowledge of falsity
● Material to payment decision
Government money or property involvementTypes of Evidence Needed:
Documentary Evidence:
● Billing records showing false claims
● Internal emails discussing fraud
● Audit reports identifying problems
● Patient files demonstrating unnecessary services
● Financial records showing kickbacks
Electronic Evidence:
● Electronic health record (EHR) data
● Software programmed for automatic upcoding
● Database queries showing patterns
● Communications about fraudulent practices
Witness Information:
● Other employees aware of fraud
● Patients affected by schemes
● Former employees with knowledge
● Vendors involved in kickbacks
First-to-File Rule:
Only the first person to file a qui tam case can receive a reward. This creates urgency:
● Multiple employees may know about fraud
● Delay risks losing whistleblower status
● Government investigations may already be underway
● Public disclosures can bar recovery
The Qui Tam Filing Process in Chicago
Filing a qui tam lawsuit requires strict compliance with procedural requirements and strategic decisions about venue and timing.
Initial Filing Requirements:
Under Seal Filing: All qui tam cases file under seal in federal court:
● Complaint remains secret for at least 60 days
● Government investigates without alerting the defendant(s)
● Extensions commonly granted for complex cases
● Your identity is protected during investigation
Disclosure Statement: You must provide the government with:
● All material evidence in your possession
● Detailed written disclosure of allegations
● Supporting documentation
● Witness information
Government Investigation Phase:
During the seal period, the Department of Justice:
● Reviews evidence with FBI and HHS-OIG agents
● Interviews witnesses
● Subpoenas additional records
● Analyzes financial impact
● Decides whether to intervene
Intervention Decision:
If Government Intervenes:
● DOJ takes over prosecution
● You remain as relator with rights
● Settlement negotiations include your counsel
● Recovery typically higher with government resources
● Your share: 15-25 percent of recovery
If Government Declines:
● You may proceed independently
● Higher percentage (25-30 percent) but harder path
● Need resources for complex litigation
● Some cases succeed without intervention
Whistleblower Protections and Retaliation
Federal and Illinois law provide robust protection against employer retaliation for whistleblowing activities.
Anti-Retaliation Provisions:
Federal Protection: The False Claims Act prohibits employers from:
● Terminating whistleblowers
● Demoting or suspending
● Harassing or discriminating
● Reducing pay or hours
● Blacklisting from future employment
Remedies for Retaliation: Successful retaliation claims can recover:
● Double back pay with interest
● Reinstatement at prior seniority
● Special damages for emotional distress
● Attorney’s fees and costs
● Punitive damages in egregious cases
Maintaining Employment During Case:
Strategic considerations for current employees:
● Cases remain sealed during investigation
● Identity protection during government review
● Anonymous filing through counsel
● Coordination with employment attorneys
● Documentation of any adverse actions
Financial Rewards for Whistleblowers
Whistleblower rewards incentivize reporting fraud and provide compensation for the risks taken in coming forward.
Calculating Your Potential Award:
Factors Affecting Percentage:
● Whether government intervenes
● Your contribution to the case
● Level of involvement in planning fraud
● Cooperation during investigation
● Significance of information provided
Recent Chicago Area Recoveries: While individual relator shares vary, recent settlements show substantial potential:
● $60 million TeamHealth settlement
● $25 million Docs at the Door judgment
● $12 million McHugh Construction settlement
● Numerous multi-million-dollar recoveries
Multiple Recovery Sources:
Federal Programs:
● False Claims Act: 15-30 percent of recovery
● SEC Whistleblower: 10-30 percent for securities fraud
● IRS Whistleblower: 15-30 percent for tax fraud over $2 million
● CFTC: 10-30 percent for commodities fraud
State and Local:
● Illinois False Claims Act rewards
● Chicago False Claims Act provisions
● Coordination increases total recovery
Why Choose Paul Padda Law
Qui tam cases demand attorneys with federal court experience, an understanding of complex healthcare regulations, and the resources to pursue lengthy litigation.
Our Comprehensive Approach:
Investigation and Analysis: We thoroughly evaluate potential cases, analyzing evidence, identifying additional witnesses, and assessing recovery potential before filing.
Strategic Filing: Our attorneys understand Northern District of Illinois procedures, working with government attorneys to present compelling cases for intervention.
Aggressive Prosecution: When the government declines, we have resources and determination to pursue cases independently, maximizing your recovery percentage.
Complete Protection: We safeguard your identity, protect against retaliation, and ensure compliance with all procedural requirements.
National Reach, Chicago Focus:
While based in Chicago, we handle whistleblower cases nationwide. Our understanding of Illinois False Claims Act coordination with federal cases provides unique advantages for Illinois whistleblowers.
No Recovery, No Fee:
We handle qui tam cases on contingency, advancing all costs and taking fees only from successful recoveries. This ensures access to experienced representation regardless of your financial resources.
Take Action Against Fraud Today
Healthcare fraud and government contract abuse drain billions from taxpayer-funded programs, harming legitimate patients and honest businesses. Whistleblowers serve a vital public function, exposing fraud the government cannot detect alone.
The decision to become a whistleblower requires courage, but the law provides substantial protection and rewards. With experienced counsel, you can expose fraud while protecting your career and maximizing your financial recovery.
Time is critical. The first-to-file rule means that a delay could forfeit your opportunity. Statutes of limitations continue running. Evidence may disappear.
Contact Paul Padda Law today at (312) 702-7000 or use our online form for a confidential consultation with experienced Chicago qui tam whistleblower attorneys. Help stop fraud while securing your financial future.