At Trombley & Hanes, P.A., our trusted Tampa criminal defense lawyers have provided full-service state and federal legal defense strategies for individuals and businesses in Florida and throughout the U.S. since 1977.
Over nearly five decades, our law firm has been proactive in monitoring the U.S. Department of Justice’s (DOJ) trends. This ensures we are always prepared to build the strongest possible defense strategies for each client’s needs.
Now, the DOJ has ocused efforts on healthcare fraud involving private insurers through the Corporate Whistleblower Awards Pilot Program.
Our Hillsborough County healthcare fraud defense attorneys are aware that the federal qui tam program under the False Claims Act already covers fraud in federal healthcare benefit programs and the new pilot program, launched on August 1, 2024, has no intention of interfering with that program. However, Principal Deputy Assistant Attorney General Nicole M. Argentieri states the purpose behind the new pilot program is “that there is no comparable whistleblower program for fraud involving private insurers.”
Our dedicated criminal defense attorneys are committed to helping our clients navigate these challenges. We understand that incentivizing whistleblowing can lead to unwarranted investigations and legal actions against innocent parties, straining insurance companies’ resources—even when the allegations are unfounded. These reports can be motivated by personal conflicts rather than genuine concerns about illegal activities, leading to unjustified accusations and disruptions to our clients’ businesses. We are here to help.
Our skilled Tampa private insurance company defense lawyers bring a unique perspective to our cases, with over 110 years of combined experience at both state and federal levels. Our team includes a former Assistant United States Attorney, an Assistant Hillsborough County State Attorney, and an Assistant Pinellas County State Attorney.
Our diverse background allows us to view your case from both sides of the courtroom, providing you with a significant legal advantage that can make a difference in your defense strategy.
How is the Department of Justice Targeting Private Insurers?
With the launch of the Corporate Whistleblower Awards Pilot Program, the DOJ is encouraging whistleblowers to report corporate misconduct and illegal activities within the private sector by offering financial rewards to individuals who provide actionable information.
That may include reports of:
- Insurance Fraud
The program focuses on uncovering various forms of insurance fraud, including false claims, overbilling, and fraudulent medical billing practices. Whistleblowers can provide insider information about schemes that result in unwarranted payouts and financial losses for insurers.
- Unlawful Denial of Claims
Whistleblowers can expose practices where insurers unlawfully deny legitimate claims to avoid payouts. This includes denying coverage for necessary medical treatments, property damage, or other covered events without a valid reason.
- Kickbacks and Bribery
The program targets kickbacks and bribery within the insurance industry. Whistleblowers can reveal arrangements where insurers or their representatives receive illicit payments in exchange for favorable treatment, such as approving claims or steering business to specific providers.
- Misrepresentation of Policies
Insurers who misrepresent the terms and conditions of their policies to customers can be targeted through the program. Whistleblowers can help uncover deceptive practices where policyholders are misled about the coverage they purchase.
- Non-Compliance with Regulations
The DOJ is interested in cases where private insurers fail to comply with state and federal regulations. This includes violating consumer protection laws, data privacy regulations, and other legal requirements governing the insurance industry.
- Manipulation of Risk Assessments
Whistleblowers can report instances where insurers manipulate risk assessments to justify higher premiums or deny coverage. This can include altering actuarial data or other fraudulent practices to misrepresent policyholders’ risk levels.
- Inappropriate Rescission of Policies
The program seeks to identify cases where insurers inappropriately rescind policies after claims are filed. Whistleblowers can expose situations where insurers cancel policies based on minor inaccuracies or pretexts to avoid paying claims.
- Discriminatory Practices
Discriminatory practices within the insurance industry, such as denying coverage or charging higher premiums based on race, gender, or other protected characteristics, are also targeted. Whistleblowers can provide evidence of systemic discrimination.
- Financial Misconduct
The program targets financial misconduct, including embezzlement, money laundering, and other financial crimes committed by insurance companies or employees. Whistleblowers can help uncover financial irregularities and illegal activities.
- Misuse of Customer Data
Misuse of customer data, including unauthorized sharing or selling of personal information, is a significant concern. Whistleblowers can reveal breaches of data privacy and insurers’ improper handling of sensitive information.
Private insurers facing the DOJ or state authorities need a skilled team of defense attorneys to navigate the complexities of insurance law, defend against fraud and whistleblower claims, mitigate financial and reputational risks, and manage the intricacies of litigation and crises.
By leveraging our experience and strategic insight, our Tampa defense attorneys play a vital role in protecting insurance companies’ interests and ensuring their continued success in a challenging regulatory environment.
Contact Our Dedicated Healthcare Defense Attorneys in Tampa, Florida, for Help Today
Do not let state or federal law enforcement intimidate you into providing a statement before you have an attorney to protect your best interests. You have the right to remain silent and to speak with an attorney. Invoke both and contact our trusted criminal defense lawyers in Florida, who have been producing actual results for real people for more than 110 combined years.
Contact us at 813-229-7918 or online to schedule a consultation to learn more.
