Claire M. Sylvia

Claire M. Sylvia's client Steven Scott, a former Humana actuary, alleged that the insurer used two sets of assumptions to project the costs of its Medicare Part D drug plans. One accurately informed its internal budgets; the other supported its bids to the government. In the complaint Sylvia and her colleagues filed in 2016, Scott alleged that the bid assumptions made Humana's promised coverage look more generous than the company intended to provide, leaving the government and Medicare beneficiaries to pay costs the insurer had committed to bear.

Sylvia's team pursued the case for years without government intervention. Humana agreed to pay $90 million in 2024, one of the largest recoveries in a declined False Claims Act case. A partner in the Oakland office of Phillips & Cohen, Sylvia has represented whistleblowers with the patient records, software knowledge, product-testing evidence, and pricing information needed to test whether government contractors delivered what they promised.

From the Senate to the Seal

Sylvia graduated from Harvard Law School, where she served on the Harvard Law Review, and clerked for Judge Mariana Pfaelzer of the United States District Court for the Central District of California. She spent six years as an Assistant Senate Legal Counsel in the office that represents the United States Senate in litigation, followed by a decade as a Deputy City Attorney in San Francisco, including work in the office's ethics unit. She then joined Phillips & Cohen.

She is the author of The False Claims Act: Fraud Against the Government, the Thomson Reuters treatise, now in its fourth edition. Courts cite it, and lawyers on both sides of the "v." consult it. She co-teaches one of the first False Claims Act courses offered at a major law school, at the University of California, Berkeley, and previously taught a similar course at New York University. She has testified to Congress on Medicaid fraud enforcement and to California lawmakers on amendments to the state's False Claims Act. In 2025, the Anti-Fraud Coalition gave her its Lifetime Achievement Award.

Cybersecurity and Defense Contracts

In the Cisco case, Sylvia represented James Glenn, a security consultant who reported flaws in video-surveillance software sold to government agencies. The complaint alleged that Cisco knew for years that the software failed to meet contractual and regulatory security requirements. Sylvia explained that the defects could allow unauthorized access to computer systems connected to the cameras, putting the security of public facilities at risk.

The 2019 resolution required Cisco to pay $8.6 million and was one of the first successful cybersecurity cases under the False Claims Act. Cisco also addressed the software problems Glenn had identified. Sylvia described the suit as a way for technical employees to alert the government to defects in products it bought while receiving whistleblower protections. The Justice Department later expanded its work in this area through the Civil Cyber-Fraud Initiative, launched in 2021.

In the Alliant Techsystems case, her client Kendall Dye had become a military-flare program manager and discovered that the company had known of a potential ignition defect for years. Tests eventually showed that the illumination flares could ignite when dropped, endangering the service members handling them. Dye urged disclosure to military customers and brought his concerns to Phillips & Cohen. The 2012 resolution was valued at about $37 million: a $21 million payment to the government and roughly $16 million in repairs to 76,000 flares. Sylvia emphasized that the company, rather than taxpayers, would bear the cost of correcting the defect.

Her other defense-contract cases include a $12.5 million Northrop Grumman settlement over military components that had not been adequately tested and an $11 million AAR resolution over aircraft maintenance.

Claims for Patient Care

Sylvia's health-care cases have involved Adventist Health System, Aetna, and the University of Pittsburgh Medical Center, addressing kickbacks, unsupported diagnosis codes, and surgeries not properly attended by the physicians who billed for them. The work required comparing patient documentation and the services delivered with the representations supporting government payments.

In April 2026, a whistleblower she represented with colleagues Jeffrey Dickstein and Amy Easton contributed to the $135 million civil and criminal resolution involving AssuredPartners and AP of South Florida. The government alleged that the brokerage submitted false income information to enroll people in subsidized Affordable Care Act plans and undermined their Medicaid applications to obtain denials. Some consumers lost access to coverage they could afford and faced costs that disrupted their treatment. Sylvia described her client's careful presentation of evidence about conduct the government could not readily detect from the insurance applications alone.

The Conditions for Payment

In testimony to a House subcommittee in 2018, Sylvia addressed proposals to relax the Stark Law's restrictions on physician self-referrals as Medicare moved toward coordinated, value-based care. She asked lawmakers to identify the specific barriers they sought to remove and to examine whether existing exceptions or agency guidance already addressed them. Her testimony drew on hospital cases in which compensation formulas rewarded physicians for the value of the business they referred.

Sylvia urged the committee to hear from affected groups before changing the conditions attached to public payment. Coordinating care, she told lawmakers, "does not eliminate the risk that the profit motive will cause health care providers to overlook or ignore the interests of patients."