What Qualifies As A Whistleblower Case?

Last updated on June 8, 2026

If you have identified fraud or another unlawful activity against the government, and you want to blow the whistle, you need to determine if you have a whistleblower case. Our firm, the Fischer Legal Group, can provide you with guidance based on our years of experience helping clients pursue actions under the False Claims Act. The following section can help you identify the types of fact patterns that may be grounds for an action under the False Claims Act (FCA):

Elements Of A Qui Tam / Whistleblower Case

There are two main aspects that must be present to create a viable False Claims Act claim. First, you must identify the presence of federal, state or city money. Review these questions to determine if this type of money is involved:

• If your employer is a health care entity: Is a large part of its business reimbursed by Medicare, Medicaid or Tricare? Is there a sign of Medicare/Medicare fraud?
• Did your employer receive a substantial state or federal grant? For example, is your employer an educational institution or a nonprofit entity that receives federal or state funding?
• Is your employer a federal contractor or subcontractor to a government contractor such as an aerospace company or Amtrak?
• Is your employer an importer who pays customs duties?
• Is your employer engaged in the construction of transportation projects such as roads or bridges or do they handle nuclear waste?
• Has your employer received federal money and misrepresented itself as a minority business or as an employer of veterans?

After you identify the source of government money, you must also identify the cause of fraud, i.e., why your employer is not entitled to the federal or state money it received:

• Are there allegations of direct billing fraud, (i.e., in the health care context, double-billing for a service reimbursable by Medicare)?
• In the health care context, are there allegations of kickbacks paid resulting in reimbursement by Medicare/Medicaid?
• Are there allegations of unlawful claims resulting in Medicare/Medicaid fraud?
• Are there allegations of violations of any federal or state statute, regulation or contractual term, in connection with the employer’s use of the federal money?
• Is your employer using federal money to provide worthless or harmful services?

If you answered “yes” to at least one of the questions above in both the source of money and fraud sections, you may have a whistleblower case. It can be intimidating to think about filing an FCA claim against your employer, but there are robust protections for whistleblowers provided by the state and federal government.

Frequently Asked Questions About Whistleblower Cases

If you are already facing the heavy reality of discovering possible fraud against the government, this FAQ section is meant to provide clear answers to common questions.

What qualifies as a whistleblower case under the False Claims Act?

A whistleblower case, often called a qui tam action, arises when someone reports fraud against the federal government. Common examples include:

• Billing fraud, such as charging for services never provided
• Upcoding, where a provider submits claims for more expensive services than those performed
• Medicare fraud whistleblower claims, involving improper use of federal health care funds
• Customs fraud, like misrepresenting goods to avoid duties

The key is that government money must be involved. If taxpayer dollars are being misused or stolen, it may fall under the False Claims Act. Grasping the basics is a starting point in figuring out your path.

What should I do once I suspect Medicare or Medicaid fraud?

If you notice suspicious billing practices like repeat charges, services billed that were never rendered or improper prescriptions, it is important to document what you have observed. Start by quietly noting specific dates, amounts, patient information (if accessible) and the nature of the suspicious activity. Keep copies of any relevant documents you legally have access to, including billing records, emails discussing questionable practices or internal memos.

The False Claims Act requires concrete evidence of fraud against government programs, so detailed documentation strengthens any potential case significantly.

Can I remain anonymous when reporting fraud?

Yes, at least at the beginning. Under federal law, whistleblowers are allowed to file cases under seal, which means their names are kept confidential during the initial stages of the investigation. Eventually, however, identities are often revealed when the case moves forward. Still, legal protections exist to guard against retaliation, and courts in New York treat those protections as a central part of whistleblower law.

How do I know if my information is strong enough for a whistleblower case?

Not every workplace concern qualifies. For a case to move forward, the information must be specific, credible and tied directly to government funds.

For instance, vague suspicions are usually not enough, but documents showing billing fraud or evidence of government fraud in contracts may be. The courts demand a clear showing that the government was financially harmed.

Contact Us For Assistance With Qui Tam Cases

The Fischer Legal Group represents clients in whistleblower cases. Learn more about what it takes to successfully pursue an FCA claim by calling us at 212-577-9231 or by sending us an email to set up an appointment.