Reporting OPO Fraud: Protecting Taxpayers and Patients
The United States organ transplant network is a multi-billion dollar system funded largely by federal taxpayers. Organ Procurement Organizations (OPOs) are legally treated as government contractors. They effectively bill Medicare for 100% of their allowable costs related to organ procurement.
Because OPOs operate on public funds, they can face liability under the False Claims Act (31 U.S.C. §§ 3729–3733) if they knowingly submit false or fraudulent claims to the government.
At Traction Law Group, we represent courageous industry insiders like procurement coordinators, surgeons, and administrative staff, who blow the whistle on fraud, waste, and abuse within the OPO system.
What Constitutes OPO Fraud?
Recent investigations by the Senate Finance Committee and other oversight bodies have identified fraud schemes within some OPOs that were designed to maximize reimbursement and manipulate government certification rankings.
We are actively evaluating whistleblower claims involving:
The “Pancreas Loophole” (Phantom Research)
OPOs are graded on “organ yield”—how many organs they recover from each donor. To artificially inflate this number, some OPOs have been accused of harvesting organs they know will never be transplanted.
- The Scheme: The OPO harvests a pancreas from a donor, labeling it for “research.”
- The Alleged Fraud: The OPO has no legitimate research partner. The organ is incinerated or discarded, but the OPO bills Medicare for the full acquisition fee and counts the organ toward its performance metrics.
- The Impact: This practice defrauds taxpayers and disrespects donor families, who believed the organ would be used to help others. Senate investigators have documented a dramatic increase in this kind of “research” organ usage and flagged it as a clear manipulation of the system.
“Financial Counting” vs. Clinical Reality
OPOs must certify that their data is accurate. Whistleblowers have described a practice they call “financial counting,” in which OPOs manipulate clinical data to bill for organs that were not medically eligible for procurement. This can include falsifying donor age, weight, or medical history to make a donor appear eligible in databases, thereby triggering reimbursement for a case that should have been declined.
Kickbacks and Improper Inducements
Federal law prohibits OPOs from offering financial rewards to hospitals or third parties in exchange for donor referrals.
- Quid Pro Quo Arrangements: We investigate claims where OPOs provide disguised payments—such as “educational grants,” inflated speaking fees, or luxury travel—to hospital administrators, coroners, or other officials to secure exclusive access to donors or to pressure staff into aggressive referral practices.
Cost Report Fraud (Waste and Abuse)
When Medicare reimburses OPOs for “costs,” there is a temptation to bury non-business expenses in the cost report. Whistleblowers have exposed OPOs using taxpayer money for:
- Private jets for executives (unrelated to organ transport).
- Lavish staff retreats and parties.
- Lobbying activities designed to weaken government oversight and maintain favorable regulations.
Your Rights as a Whistleblower
Under the False Claims Act, individuals who report fraud against the government are entitled to both protection and potential compensation. This is known as a Qui Tam lawsuit.
- Financial Reward: If the government recovers funds based on your information, you may be entitled to 15% to 30% of the total recovery. In the healthcare sector, these recoveries can reach into the millions of dollars.
- Job Protection: You cannot legally be fired, demoted, harassed, or threatened for reporting fraud. If your employer retaliates, you can sue for double back pay, reinstatement, and attorneys’ fees.
Confidentiality Is Key
If you are considering blowing the whistle, it is important to speak with an attorney before you go public. The False Claims Act has specific procedural requirements that must be followed to preserve your right to a reward and to protect your claims.
Traction Law Group and our co-counsel provides a secure, attorney–client privileged environment to discuss what you know. We can evaluate your evidence, explain your risks, and guide you through the process of holding negligent or fraudulent organizations accountable.
Help us clean up the system. Contact us today at 833-236-8253.
