Michigan False Claims Act Attorneys | Confidential Whistleblower Case Review

If you have inside knowledge that a hospital, physician practice, home health agency, hospice, laboratory, pharmacy, skilled nursing facility, or other health care provider is defrauding Medicare, Medicaid, TRICARE, or another government-funded program, you may be entitled to file a confidential qui tam lawsuit under the federal False Claims Act (31 U.S.C. §§ 3729–3733) and recover a share of what the government recovers. Szura & Delonis, PLC represents billing specialists, coders, nurses, physicians, compliance officers, office managers, and other insiders throughout Michigan who have witnessed health care fraud and want to do something about it — without losing their career, their license, or their peace of mind in the process.

Unlike a general plaintiff’s firm bolted onto whistleblower work, our qui tam practice is built on the same foundation as our health care regulatory practice: attorney Louis Szura has spent his career advising physicians, health systems, and provider groups on Stark Law, the Anti-Kickback Statute, HIPAA, and Medicare/Medicaid billing compliance — which means we don’t have to learn health care regulation to evaluate your case. We already know what the fraud looks like from the inside, because we’ve spent years advising providers on how to stay on the right side of the line you’re telling us they crossed.

Our Michigan Qui Tam & Whistleblower Services Include:

Confidential Whistleblower Case Evaluation

Before you risk your career or sign anything, you deserve a candid, privileged assessment of whether what you’ve seen actually rises to a viable False Claims Act case. Not every billing error is fraud, and not every viable case is worth the years of litigation it may require. We give you a direct answer.

Our confidential intake process evaluates:

• Whether the government was actually billed — qui tam liability requires a false claim submitted to a federal or state program, not just bad medicine or sloppy documentation
• Whether you qualify as an “original source” under the False Claims Act’s public disclosure bar
• Whether your evidence is strong enough to survive dismissal and motivate a DOJ intervention decision
• The realistic timeline and emotional toll of pursuing a sealed federal case, so you go in with your eyes open

We never charge a fee to evaluate your case, and initial conversations are protected by attorney-client privilege whether or not we end up filing.

Medicare & Medicaid Billing Fraud

Billing fraud is one of the most common forms of health care fraud, and it takes many forms our attorneys have evaluated firsthand from the compliance side:

• Upcoding — billing for a more expensive service or higher-acuity patient than was actually provided
• Unbundling — separately billing procedures that should be billed together at a lower combined rate
• Phantom billing — billing for services, tests, or equipment never actually provided
• Medically unnecessary services — ordering or performing tests, procedures, or hospital admissions without medical justification, driven by profit rather than patient need
• Upcoded or falsified diagnosis codes used to inflate Medicare Advantage risk-adjustment payments
• Falsified time-based billing, including therapy minutes, evaluation and management (E/M) coding, and telehealth visit documentation

Kickbacks, Stark Law & Referral Fraud

The Anti-Kickback Statute (42 U.S.C. § 1320a-7b) and the Stark Law (42 U.S.C. § 1395nn) prohibit financial arrangements that reward referrals of federally funded patients. Violations of either statute can independently support a False Claims Act case, because claims submitted in violation of Stark or the AKS are considered false claims as a matter of law. We evaluate:

• Sham medical director or consulting agreements paid to referring physicians
• Above-fair-market-value lease or equipment rental arrangements with referral sources
• Improper compensation tied to the volume or value of referrals
• Physician-owned distributorship (POD) arrangements in surgical device sales
• Marketing and “sales rep” arrangements with hospices, home health agencies, and labs that function as disguised kickbacks

Pharmaceutical, Device & Off-Label Marketing Fraud

We evaluate whistleblower claims involving pharmaceutical and medical device manufacturers, including off-label marketing that causes providers to submit non-reimbursable claims, illegal speaker-program and consulting-fee kickback schemes, and manipulation of Average Sales Price (ASP) or Best Price reporting that inflates federal reimbursement.

Hospice, Home Health & Skilled Nursing Fraud

Post-acute care is one of the most heavily scrutinized sectors in federal health care fraud enforcement. We evaluate cases involving ineligible hospice enrollment of patients who are not terminally ill, falsified plans of care and physician certifications, “churning” of long-stay hospice patients to maximize per-diem payments, and staffing fraud in skilled nursing facilities that bills for care never actually delivered.

Filing Suit Under Seal & the DOJ Investigation Process

A qui tam case is filed under seal — meaning it is confidential and not served on the defendant — while the U.S. Department of Justice or the Michigan Attorney General’s office investigates. We manage this process for you from filing through resolution:

• Drafting a detailed, evidence-based Disclosure Statement to the government (separate from the complaint) laying out exactly how the fraud works
• Coordinating with DOJ attorneys and federal agents (often HHS-OIG or FBI) throughout the seal period, which frequently lasts a year or longer
• Advising you on what you can and cannot say, collect, or do while the case is under seal — including protecting you from committing an unintentional HIPAA or trade-secret violation while gathering evidence
• Litigating the case independently if the government declines to intervene, which we are prepared to do given our firm’s underlying health law litigation experience

Whistleblower Retaliation Protection

The False Claims Act’s anti-retaliation provision, 31 U.S.C. § 3730(h), protects employees, contractors, and agents from being fired, demoted, harassed, or otherwise retaliated against for investigating or reporting suspected fraud — even before a lawsuit is filed. If you’ve already faced retaliation, or are worried about it, we advise on:

• Documentation strategies to preserve your retaliation claim before you report internally or file suit
• Separate retaliation damages, including reinstatement, double back pay, and litigation costs
• Coordinating whistleblower and employment claims so one doesn’t undermine the other

Why Health Care Insiders Choose Szura & Delonis for Qui Tam Cases

• We Represent the Providers You’re Reporting — So We Know How the Fraud Actually Works
  Louis Szura’s health care practice advises physicians and provider groups on the exact regulations at issue in most qui tam cases: Stark Law, the Anti-Kickback Statute, HIPAA, and Medicare/Medicaid compliance. That means when you describe a billing pattern or referral arrangement, we recognize immediately whether it’s a compliance gray area or a textbook false claim — most whistleblower firms have to hire a consultant to tell them that.
• Confidentiality From the First Phone Call
  We understand that reporting your employer is one of the hardest professional decisions you will ever make. Every initial consultation is privileged and confidential, and we discuss realistic risks — including career impact — honestly before you commit to anything.
• Decades of Michigan Litigation Experience
  If the government declines to intervene, your case doesn’t end — it just means we litigate it ourselves. Our attorneys have decades of combined complex commercial and health care litigation experience in Michigan state and federal courts, including the U.S. District Courts for the Eastern and Western Districts of Michigan.
• We Tell You the Truth About Weak Cases
  Not every suspicion is a viable federal case, and pursuing a weak claim can expose a relator to real professional and financial risk for little chance of recovery. We give straight answers on viability before you take on that risk — even when the honest answer is “not yet” or “no.”
• A Firm Structure Built for High-Stakes, Confidential Matters
  Qui tam cases can run for years under seal. You need a firm that will still be responsive, prepared, and discreet in year three of a sealed federal investigation — not just at the initial intake call.

Frequently Asked Questions About Michigan Qui Tam & Healthcare Fraud Whistleblower Cases

What is a qui tam lawsuit?

A qui tam lawsuit is a case filed by a private citizen — called a “relator” — on behalf of the federal government under the False Claims Act, alleging that a person or company defrauded a government program. The relator’s identity and the existence of the case are kept confidential (“under seal”) while the government investigates, and if the case succeeds, the relator can recover a percentage of the government’s total recovery.

How much can a whistleblower recover in a Michigan qui tam case?

Relators are generally entitled to between 15% and 25% of the government’s recovery if the DOJ intervenes in the case, or 25% to 30% if the relator’s attorneys litigate the case successfully without government intervention. Recoveries are calculated based on the total amount recovered by the government, which in health care fraud cases involving Medicare or Medicaid can range from hundreds of thousands to hundreds of millions of dollars, depending on the scope of the fraud.

Will my employer find out I filed a qui tam case?

Not immediately. Qui tam complaints are filed under seal, meaning the case is confidential and not served on the defendant while the government investigates — a process that commonly takes a year or more. Even if the case eventually becomes public, federal law under 31 U.S.C. § 3730(h) makes it illegal for an employer to retaliate against you for reporting suspected fraud, and separate damages are available if they do.

What qualifies as healthcare fraud under the False Claims Act?

Common examples include billing Medicare or Medicaid for services never provided, billing for a higher level of service than what was actually delivered (upcoding), performing or ordering medically unnecessary procedures, paying or receiving kickbacks for patient referrals, violating the Stark Law’s physician self-referral restrictions, and falsifying documentation to support claims for reimbursement. If you’re unsure whether what you’ve observed qualifies, that’s exactly what a confidential case evaluation is for.

Do I need direct proof, or is suspicion enough to talk to a lawyer?

You don’t need airtight proof to have an initial conversation — insiders often have partial documentation, personal observations, or access to systems that, combined with legal analysis, reveal a pattern. However, the False Claims Act generally requires relators to bring non-public, firsthand information (“original source” status), so the strength of what you personally witnessed and can document matters a great deal to case viability. We’ll tell you candidly what you have and what you still need.

How long does a Michigan qui tam case take?

Health care qui tam cases typically take one to several years from filing to resolution. The government has an initial 60-day period to investigate under seal, but in practice almost always requests — and receives — extensions, particularly in complex health care billing fraud cases that require subpoenaing claims data and interviewing witnesses. Patience and confidentiality throughout this period are critical to the case’s success.

Can I be fired for reporting healthcare fraud?

It is illegal for an employer to fire, demote, harass, or otherwise retaliate against you for investigating or reporting suspected fraud under the government, under both the False Claims Act’s anti-retaliation provision and, in many cases, Michigan’s Whistleblowers’ Protection Act. If retaliation occurs, you may be entitled to separate damages, including reinstatement and double back pay, in addition to any qui tam recovery.

What’s the difference between reporting fraud to HHS-OIG directly and filing a qui tam lawsuit?

Reporting to the HHS Office of Inspector General or a compliance hotline can trigger an investigation, but it does not entitle you to a share of any government recovery, and it may not give you the same anti-retaliation protections that come with formally filing a False Claims Act case through counsel. Filing a qui tam lawsuit under seal, with counsel managing the disclosure statement and DOJ coordination, is the path that preserves both your financial interest and your legal protections.

Does it cost anything to talk to a qui tam attorney?

No. Initial case evaluations are confidential and free of charge. Qui tam cases are typically handled on a contingency basis, meaning our fee comes from a percentage of any recovery — you do not pay hourly fees out of pocket to pursue a viable case.

I work in health care compliance and I’m required to report internally — should I still call a lawyer first?

In most cases, yes — talk to counsel before you report internally if you believe the conduct may rise to fraud rather than a correctable compliance gap. How and when you report internally can affect both your “original source” status under the False Claims Act and your retaliation protections. A short confidential conversation before you act can preserve options you can’t get back once you’ve reported through the wrong channel.

Representative Matters

Our attorneys have evaluated and pursued whistleblower matters involving Medicare and Medicaid billing fraud, kickback and Stark Law arrangements, and false certifications for payment across a range of health care provider types.

All matters handled with strict confidentiality. Because qui tam cases are filed under seal and relator identities are initially protected by law, we do not often publish case-specific details. Representative practice descriptions are listed for illustrative purposes only and do not guarantee similar results.

Think You’ve Witnessed Healthcare Fraud? Speak With a Michigan Qui Tam Lawyer Today

The government cannot recover money it doesn’t know is missing — and you may be the only person positioned to tell them. Coming forward is not an easy decision, and you shouldn’t have to make it alone or without knowing your risks and protections up front. Every conversation with our firm about a potential qui tam case is confidential, and there is no cost to find out where you stand.

Call or email us today for a confidential, no-cost case evaluation. The sooner you talk to counsel, the more options you preserve — both to protect your case and to protect yourself.

Address: 29777 Telegraph Rd #2401 Southfield, MI 48034

Phone: (248) 716-3600

Email: admin@szuradelonis.com

Michigan Qui Tam & Healthcare Fraud Whistleblower Representation: Areas We Serve

Located in Southfield, Szura & Delonis, PLC represents health care fraud whistleblowers statewide, with particular depth in the Detroit metro health systems, hospital networks, and physician groups regulated out of Southeast Michigan. Qui tam cases are filed in federal court, so our attorneys regularly appear before:

• U.S. District Court for the Eastern District of Michigan (Detroit and Ann Arbor divisions) — where the majority of Michigan health care qui tam cases are filed, covering Wayne, Oakland, Macomb, and Washtenaw Counties
• U.S. District Court for the Western District of Michigan — for whistleblowers employed by providers in western and northern Michigan
• Michigan Attorney General’s Health Care Fraud Division — for cases involving Michigan Medicaid False Claims Act violations under MCL 400.601 et seq., which runs parallel to federal qui tam claims

We represent health care employees and insiders regardless of where in Michigan their employer is located, including major health systems and provider networks in Oakland County (Southfield, Troy, Royal Oak, Farmington Hills, Pontiac), Wayne County (Detroit, Dearborn, Livonia), Macomb County (Sterling Heights, Warren, Clinton Township), and Washtenaw County (Ann Arbor, Ypsilanti).

Helpful Resources for Michigan Healthcare Fraud Whistleblowers

• “What Counts as an ‘Original Source’ Under the False Claims Act? A Guide for Michigan Whistleblowers“
• “Upcoding, Unbundling & Phantom Billing: How Medicare Fraud Actually Gets Caught“
• “Stark Law vs. the Anti-Kickback Statute: What Michigan Physicians (and the Employees Who Report Them) Need to Know“
• “What Happens After You File a Qui Tam Complaint? The Seal Period, Explained“
• “Can You Be Fired for Reporting Healthcare Fraud in Michigan? Your Rights Under Federal and State Law“

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