The False Claims Act (FCA) is a vital tool in combating healthcare fraud and protecting taxpayer dollars. While federal and state laws work in tandem to prevent abuse within the U.S. healthcare system, fraudulent activities still occur. Whistleblowers play a crucial role in exposing such fraud. If you suspect healthcare fraud in Alabama or elsewhere, consult an experienced healthcare fraud lawyer to safeguard your rights.
Federal Law
The U.S. False Claims Act (31 U.S.C. §§ 3729–3733) addresses fraud against federally funded programs like Medicare and Medicaid. It allows private individuals (whistleblowers) to file qui tam lawsuits on behalf of the government. Successful whistleblowers may receive 15–30% of recovered funds. Given the complexity of these cases, legal guidance is essential.
Alabama State Law
Alabama does not have a state-level False Claims Act. However, it enforces anti-fraud statutes targeting Medicaid fraud. Under the Alabama Code § 22-1-11, submitting false Medicaid claims or engaging in kickbacks is a felony, punishable by fines up to $10,000 and imprisonment for 1–5 years per offense . Additionally, Alabama Code § 13A-9-150 criminalizes filing false claims under public assistance programs, including Medicaid
Define “Qui Tam”
“Qui tam” derives from the Latin phrase “qui tam pro domino rege quam pro se ipso in hac parte sequitur,” meaning “he who sues on behalf of the king as well as for himself.” It allows private citizens to sue on behalf of the government if they uncover fraud against public programs. Whistleblowers must present credible evidence and follow proper procedures to receive protections and potential rewards.
Recent Alabama Healthcare False Claims Act Cases
Saad Healthcare Settlement – In 2025, Saad Healthcare agreed to pay $3 million to resolve allegations of submitting false claims to Medicare for hospice patients who were not terminally ill. The qui tam lawsuit was filed by former employees, who received $540,000 from the settlement.
Northern Alabama Pain Specialists Case – In 2020, seven individuals associated with Northern Alabama Pain Specialists were charged in a $41 million healthcare fraud and kickback scheme. The clinic allegedly billed for unnecessary services and received illegal kickbacks.
Alabama Healthcare Fraud by Region
Healthcare fraud can occur statewide, but certain areas may be more susceptible due to population size and healthcare infrastructure:
Birmingham: As Alabama’s largest city, Birmingham has a dense network of healthcare providers, increasing the potential for fraudulent activities.
Huntsville: With rapid growth and expanding medical facilities, Huntsville faces challenges in monitoring healthcare claims.
Mobile: Home to major hospitals and clinics, Mobile has been the site of significant fraud cases, including the Saad Healthcare settlement.
Montgomery: The state capital’s numerous healthcare institutions make it a focal point for Medicaid and Medicare services.
Tuscaloosa: With a mix of urban and rural healthcare providers, Tuscaloosa requires vigilant oversight to prevent fraudulent billing.
What Should I Do If I Suspect Healthcare Fraud in Alabama?
If you suspect healthcare fraud in Alabama,
- Consult an Attorney: Reach out to an experienced Alabama healthcare whistleblower attorney to understand your rights and the legal process.
- Maintain Confidentiality: Avoid discussing your suspicions with coworkers or others to protect the integrity of any potential investigation.
- Document Evidence: Gather and securely store any relevant information or documentation that supports your claim.
Understand Protections: While Alabama lacks a state False Claims Act, federal laws offer protections and potential rewards for whistleblowers.
Note: While this guidance focuses on Alabama, the principles apply nationwide for those facing similar healthcare fraud situations.