Claire M. Sylvia

Her Medicare cases since have turned on the same kind of number. On March 11, 2026, Aetna paid $11.5 million to resolve a case, brought by a former employee who had watched the company's chart reviews, alleging that from 2018 to 2023 it submitted morbid-obesity diagnosis codes for Medicare Advantage patients whose body-mass index was below 30 or whose records did not support the diagnosis; the Justice Department intervened. "A diagnosis of Morbid Obesity has a high risk adjustment value," Sylvia said; coders had been encouraged to add it without regard to the patient's weight, invalid diagnoses were left uncorrected, and the government's costs went up. On April 7, 2026, AssuredPartners and AP of South Florida agreed to pay $135 million to resolve allegations, brought by a whistleblower she represented with Jeffrey Dickstein and Amy Easton, that the brokerage coached low-income applicants to report false incomes on Affordable Care Act applications, used the same fabricated figure, the exact minimum for a full subsidy, across thousands of them, invented qualifying life events to sell outside the enrollment window, and sabotaged Medicaid applications so that people who could have had free coverage were moved into plans with deductibles they could not pay; the subsidiary pleaded guilty and one of its executives was sentenced to twenty years. Dr. Jonathan D'Cunha, a cardiothoracic surgeon who had been vice chair of his department at the University of Pittsburgh Medical Center, brought her the allegation that Dr. James Luketich performed as many as three complex operations at once, absent from the key and critical portions of each while patients lay under anesthesia longer than they needed to; the complaint was filed in 2019, the government intervened, and on February 27, 2023 UPMC, its physicians' group and Luketich agreed to pay $8.5 million. D'Cunha had stepped forward at a personal cost, she said, and that was "exactly the kind of conduct the False Claims Act was intended to encourage and reward." Adventist Health paid $14.1 million in a kickback and self-referral case she brought.

Flaws in the Cameras

James Glenn was a security consultant at a Danish company that sold Cisco products, and in 2008 he sent Cisco a detailed report on flaws in its Video Surveillance Manager, the software that lets an agency connect and manage its cameras from one place; the flaws, he wrote, would let an intruder into the surveillance system and into any computer network connected to it. He was fired in 2009. Sylvia filed his complaint under seal in the federal court in Buffalo in 2011, with Constantine Cannon as co-counsel, alleging that federal and state agencies had bought the system from 2007 to 2014 on the representation that it met contractual and regulatory security requirements it did not meet. On July 31, 2019, Cisco agreed to pay $8.6 million, $2.6 million to the federal government and up to $6 million to fifteen states, the District of Columbia and their cities and counties, and Glenn received twenty percent. The flaws, Sylvia said, were "so severe that they compromised the security of the video surveillance systems" and of every computer system connected to them. It was among the first cybersecurity cases resolved under the False Claims Act, and in October 2021 the Justice Department announced a Civil Cyber-Fraud Initiative to bring more of them.

Kendall Dye became the flare program manager at ATK Thiokol in 2005 and found that the company had known since redesigning its illumination flares in 2000 that they might ignite if dropped from ten feet or less, and had not run the safety tests the Air Force required. The flares are three-foot tubes of propellant that burn at more than 3,600 degrees, used for night operations and search and rescue. When the Navy demanded tests before it would buy, in 2005, the flares ignited at ten feet and at five, and the company's own calculations put the threshold at eleven and a half inches; production stopped. Dye's complaint was filed in the District of Utah in 2006, and on April 23, 2012 ATK agreed to pay $21 million and to retrofit 76,000 flares at a cost of about $16 million more. ATK had delivered the flares untested, Sylvia said, "despite ATK's awareness of a potential dangerous defect." Her other defense cases produced $12.5 million from Northrop Grumman over electronic components in military navigation systems that had not been tested as the contract required, $11 million from AAR Corp. over aircraft maintenance, with a $429,000 fine from the Federal Aviation Administration beside it, and $1 million from Rocky Mountain Instrument Co. over exports controlled by the International Traffic in Arms Regulations.

Reasonable Inquiry

On July 17, 2018, before the House Ways and Means Subcommittee on Health, Sylvia testified on proposals to relax the Stark Law's limits on physician self-referral as Medicare moved toward coordinated, value-based care. She asked the members to name the specific barriers they meant to remove and to check whether an existing exception or agency guidance already covered them, drawing on hospital cases in which compensation formulas had rewarded physicians for the value of the business they referred, and she asked them to hear from the people affected before changing the conditions on public payment. Coordinating care, she told them, "does not eliminate the risk that the profit motive will cause health care providers to overlook or ignore the interests of patients." She had testified to the House Oversight Committee on April 25, 2012 on whether the government was adequately protecting taxpayers from Medicaid fraud, and to the California Senate Judiciary Committee on the 2009 amendments to the state's False Claims Act.

She came to the statute by way of the government. After Harvard Law School, where she was on the Harvard Law Review, she clerked for Judge Mariana Pfaelzer of the Central District of California, served from 1989 to 1995 as an Assistant Senate Legal Counsel in the office that represents the United States Senate in litigation and advises its committees, and from 1995 to 2005 as a Deputy City Attorney in San Francisco, in the office's ethics unit, before joining Phillips & Cohen, where she is a partner in the Oakland office. She is the author of The False Claims Act: Fraud Against the Government, the Thomson Reuters treatise now in its fourth edition with annual supplements, cited by courts and consulted by lawyers on both sides of the "v."; she co-teaches with her partner Erika Kelton the whistleblower-law course at Berkeley Law that was among the first offered on the statute at a major law school, and taught a similar course at New York University. When Universal Health Services asked the Supreme Court in 2016 to narrow the statute, she put the rule she has worked under in one sentence, "The False Claims Act does not apply to mistakes or accidents," and its corollary: only those who know they are not complying with the law, or fail to make a reasonable inquiry, are subject to it.