For physician practices, health systems, and other providers facing government billing scrutiny, a new wave of professional data analysts is changing how False Claims Act complaints surface.
Traditional periodic audits may no longer catch a problem before an outside data-mining firm or regulator does.
In a recent video interview with Medical Economics, the publication examined why a growing share of False Claims Act complaints now originate from data miners rather than insiders. The Department of Justice has directed officials to complete certain reviews faster as a result. George B. Breen, Member of the Firm of Epstein Becker Green, counsel to health care providers on False Claims Act defense and government investigations, joined the discussion. He addressed what the shift toward data-driven whistleblower activity means for how practices should approach risk.
The interview followed new data showing that more than 45% of False Claims Act whistleblower complaints filed since 2024 have come from professional data analysts. Recoveries under the statute reached a record $6.8 billion in 2025. With CMS claims data now publicly available and artificial intelligence making billing anomalies easier to spot, Breen addressed why periodic audits and internal reporting alone may no longer be sufficient. He also discussed how providers can identify exposure before an outside data-mining firm or government investigator does.
Get in Touch
To discuss how your organization can monitor billing data, address anomalies early, and prepare for a potential False Claims Act inquiry, contact George Breen at gbreen@ebglaw.com.
