What the rise of professional data miners means for your False Claims Act risk

Have you heard that over 45% of False Claims Act whistleblower complaints filed since 2024 have come from professional data miners rather than traditional insiders? This comes as False Claims Act recoveries hit a record $6.8 billion in 2025, and the Department of Justice is encouraging officials to work directly with credible data miners, directing them to complete initial reviews of certain benefits-fraud complaints within 60 to 120 days rather than allowing cases to remain under seal for years.

With CMS claims data now publicly available and AI making billing anomalies easier to identify, health care providers may need to fundamentally change their approach to compliance — a shift underscored by cases like the Dallas jury verdict that found a practice liable for Medicare fraud, which could result in more than $300 million in penalties.

Traditional compliance strategies, such as periodic audits and internal reporting, may no longer be sufficient as enforcement actions accelerate. Providers who want to stay ahead of increased scrutiny are continuously monitoring billing data, investigating unusual patterns earlier and preparing for government inquiries before a complaint is ever filed. Identifying potential areas of exposure before outside data-mining firms or government investigators do is quickly becoming a baseline expectation rather than a competitive edge.

Medical Economics spoke with George Breen, a health care attorney with Epstein Becker Green, about this new risk that practices face and how they should approach it.