The Personal Toll of Whistle-Blowing


On the morning of September 17, 2009, Darren Sewell left his office at Freedom Health, the Tampa health-insurance company where he was a vice-president, and climbed into his Chevy Tahoe. He drove to Sonny’s BBQ, a restaurant nearby, where he picked up barbecue sauce for the sandwich he had brought for lunch. Then he continued on until he reached a drab stretch of road lined with gas stations and scraggly palm trees, where he pulled into a parking lot and waited, as discreetly as possible, to meet his F.B.I. handler.

Sewell, a physician, was thirty-four years old, six feet four inches tall, and broad-shouldered, with an earnest smile and barely perceptible dimples. He was born with one eye slightly crossed, and it still drifted when he was tired or feeling stressed; strangers sometimes found it disconcerting, but his quick wit and easy sense of humor usually dispelled any tension. In the parking lot, Sewell looked around nervously. He noticed that there was a large puddle in the parking space next to his car, where the F.B.I. agent would pull in, so he moved to another space, only to find himself boxed in by other cars. He moved again, but then decided that there were too many people milling around, and drove to a smaller parking annex. There, he found that he could no longer pick up the radio station he’d been listening to, so he pulled out, turned around, and backed his car into the same space, thinking that might help. Later, in audio notes that Sewell recorded about the day, he made fun of his clumsy attempt to be inconspicuous. “I realized I had changed my parking spot about seventeen times,” he said. “And had everyone that was sitting there for lunch probably wondering whether to call the F.B.I. to find out whether I was a terrorist or not.”

Sewell had joined Freedom, which made most of its money administering Medicare plans, in 2007. The financial crisis was beginning, and employment opportunities were drying up across the country, but the sector of the health-care industry that drew its revenue from Medicare was booming. During his time at Freedom, Sewell had become convinced that the company was defrauding the government of hundreds of millions of dollars by carrying out a sophisticated set of scams targeted at a new program called Medicare Advantage. Sewell, an avid reader of John Grisham novels, had been so appalled by what he observed, and so intrigued by the romanticism of going undercover, that he had decided to become a whistle-blower.

When Ed Ortega, the F.B.I. agent, arrived, Sewell joined him in his vehicle. Sewell had told Ortega that a meeting at Freedom later that day might provide valuable evidence. The two men had been working together for several weeks, and they got along well—Sewell later described Ortega as “absolutely the friendliest guy there could be”—but this was their first time out in the field together, and Sewell was taken aback by Ortega’s stern demeanor. “I just didn’t see him as a very intimidating person. Well, when I was in the car with him, I cannot begin to explain how wrong I was,” Sewell later said. “He reached out and shook my hand and nearly broke it . . . you just got this feeling that, my God, if he had to, he could just reach over and snap your neck without even thinking about it.”

Ortega had been a special agent with the F.B.I. for seventeen years, and he was experienced in health-care-fraud investigations. He tried to set Sewell at ease as he rolled up a piece of clear tape and stuck it inside Sewell’s shirt pocket, preparing to outfit him with a small recording device. Sewell was surprised by how low-tech the recorder looked, like something you’d find in a cluttered kitchen drawer. “It reminded me of kind of an old TV-antenna connector, but miniaturized,” he said. The device would record for between two and four hours, and under no circumstances should Sewell fiddle with it. It wasn’t easy to get a judge’s permission to secretly record executives, and strict rules governed how it could be done; Ortega would have to be the one to turn the device on and off.

The wire would capture everything that Sewell did. “All I could keep thinking of was, the whole world in court someday is going to know what radio station I listen to, and hear my pen click, and, you know, when I’m sitting here scratching myself, is the stenographer going to realize that that rustling isn’t papers, it’s me scratching myself?” Sewell said. “But Ed had said in an earlier conversation not to worry, these people are professionals, they’ve heard you burp and fart. . . . You’ll never surprise these guys.”

Ortega warned Sewell that he would probably feel conspicuous, as if everyone he encountered knew immediately that he was wearing a wire, but urged him to go about his day as normal. He gave Sewell some final words of advice—“Don’t worry, just relax”—and then sent him back to Freedom, the recorder running in his pocket.

The first documented whistle-blowing case in the United States took place in 1777, not long after the signing of the Declaration of Independence, when a group of naval officers, including Samuel Shaw and Richard Marven, witnessed their commanding officer torturing British prisoners of war. When they reported the misconduct to Congress, the commanding officer charged Shaw and Marven with libel, and both men were jailed. The following year, Congress passed a law protecting whistle-blowers, and Shaw and Marven were acquitted by a jury.

Institutional denial, obfuscation, and retaliation are hallmarks of many whistle-blowing cases. In the late nineteen-sixties and early nineteen-seventies, the New York City police officer Frank Serpico captured the popular imagination when he tried to expose rampant bribery and corruption in the N.Y.P.D., culminating in an episode in which he was shot in the face under bizarre circumstances during a drug raid. (He eventually took his evidence to the Times, which published a front-page story that led to an independent investigation that ultimately validated his allegations.) Since then, notable whistle-blowers have included Karen Silkwood, who revealed worker-safety issues inside an Oklahoma nuclear plant; Jeffrey Wigand, who went on “60 Minutes” in 1996 and disclosed that the Brown & Williamson Tobacco Corporation had misled the public about the addictive and carcinogenic properties of cigarettes; Sherron Watkins, who exposed accounting fraud at Enron; and, in 2013, the National Security Agency contractor Edward Snowden, who leaked classified information about vast government surveillance programs. Whistle-blowers are usually, but not always, employees or members of the group on which they’re blowing the whistle; after they do so, their lives are never the same.

To become a whistle-blower, Darren Sewell had filed what is known as a “qui tam” complaint—the term comes from a Latin phrase that translates as “he who brings an action for the king as well as for himself.” Qui-tam cases are brought under the False Claims Act, a law passed in 1863, under President Lincoln, in response to war profiteers peddling defective weapons and ailing mules to the Union Army. The law allows private citizens to file suit on behalf of the government against anyone believed to be defrauding the government. The vast majority of these cases involve health care. To some, qui-tam cases are controversial because whistle-blowers share in the money that the government recovers. This provision was included in the legislation to encourage individuals, especially those who might be involved in the theft themselves, to report the abuse. One of the bill’s sponsors, Senator Jacob Howard, of Michigan, said that he had based the qui-tam provision on the “old-fashioned idea of hold[ing] out a temptation, and ‘setting a rogue to catch a rogue’ . . . a reward for the informer who comes into court and betrays his co-conspirator.”

The False Claims Act was strengthened in 1986, after a push by Senator Charles Grassley, of Iowa. Whistle-blowers can now share between fifteen and twenty-five per cent of the recovery, depending on such factors as the importance of their contribution. This change was an effort to recognize the financial toll of being a whistle-blower, both in lost employment and in legal fees incurred during the arduous process of building a case. The law effectively turned average citizens into a fleet of amateur federal agents, and it helped to reveal the staggering amount of money wrongfully extracted from government programs. A recent government report indicated that in 2017 alone almost $2.6 billion was recovered in health-care-fraud judgments and settlements. Two hundred and sixty-two million dollars of that was awarded to whistle-blowers.

Medicare Advantage, the program that Sewell believed Freedom was abusing, is at the center of a growing number of fraud cases, some of which involve the biggest names in the health-insurance industry. The regulations around the issue are complicated, however, and legal questions about what constitutes prosecutable fraud are still the subject of debate. In 2017, the Department of Justice joined a multimillion-dollar case against the nation’s largest insurer, UnitedHealth Group, alleging widespread fraud dating back to 2006. The Justice Department is also investigating several other health insurers, including Anthem, Humana, Cigna, Health Net, and Aetna. An analysis co-authored by Fred Schulte, at the Center for Public Integrity, estimated that insurance companies had received nearly seventy billion dollars in undeserved Medicare Advantage payments between 2008 and 2013.

Peter Budetti, who served in health-policy roles in Congress and as a deputy administrator at the Centers for Medicare and Medicaid Services (C.M.S.), told me that experts believe the real figures are up to ten times what the government actually recoups. “We’ve never been able to get a direct measure of exactly how much fraud there is, but one of the clearest indicators is that, the more money is spent on fighting fraud, the more money is recovered by the government,” he said. He now works as an attorney at Phillips & Cohen, a firm that specializes in whistle-blowing cases. Fraud perpetrated by companies in the health-care industry, he said, is especially pernicious. “On the one hand, they are stealing public money,” he told me. “And on the other hand that money is not going to where it’s supposed to go, which is to taking care of people. They aren’t stealing from people who are selling imported shoes. They are stealing from people who would otherwise be immunizing kids or delivering babies. That’s the heart of it.”

Critics of the whistle-blower payments argue that the windfalls could encourage people to induce corporate sabotage. William P. Barr, President Trump’s nominee for Attorney General, has called the False Claims Act an “abomination” spurred by “the mercenary motives of private bounty hunters.” But Budetti told me that, in his experience, most whistle-blowers are driven by frustration and moral outrage, not by money. “Whistle-blowers are one of the absolutely central ingredients in fighting health-care fraud,” Budetti said. “We’re lucky we have a system that encourages them to come forward.”

Darren Sewell grew up in Champion, Ohio, a small city about forty minutes from Cleveland, the oldest of three boys. Their father, Rickye, ran a family company that made industrial switchgear and other manufacturing equipment; their mother, Barbara, was a stay-at-home mom when the kids were young, and then took a job in administration at a medical-supply company. Most of the Sewell boys’ free time was devoted to sports: Sewell played baseball, basketball, and varsity soccer, and was a competitive swimmer, eventually qualifying for nationals.

Sewell was the academic star of the family and, according to his brother David, a magnanimous friend. “Darren didn’t care about material things,” David told me. “He drove around in a ratty car. But he never hesitated to buy everyone’s drinks, or to treat when we went out to dinner or on trips.” After graduating from high school, Sewell attended the University of Akron, and then earned his medical degree in an accelerated four-year program at Northeast Ohio Medical University. He did his residency at a hospital in downtown Orlando, and thrived in the adrenalized atmosphere of the emergency room. “In the E.R., you’ve got to be able to assess a patient really quickly, and figure out what’s wrong, handle that, and move on. He was so good at that,” David said. “He had stories: ‘I’ve got one finger plugging the guy’s heart from a gunshot wound and I’m making coffee with the other.’ ” Sewell saw a lot of trauma patients, and the work, though exciting, was draining. “The daily grind of being an E.R. doctor—he didn’t want to continue that,” David said.

Sewell was also interested in business, and he eventually left emergency medicine; he spent a few years working at H.M.O.s before joining Freedom Health. The company was owned by Kiran C. Patel, a cardiologist who was born to South Asian parents in Zambia and immigrated to the U.S. in 1976. Patel was already an enormously successful entrepreneur. In the nineteen-nineties, he took over a struggling H.M.O. called WellCare, which he sold to a group of investors in 2002 for two hundred million dollars. He was the financial backer of a high-end oceanfront hotel and resort near Tampa, and an investor in the Tampa Bay Times. In 2007, he bought Freedom and a smaller company, called Optimum Healthcare, for fifty million dollars, and joined them under the umbrella of one parent company. Freedom had been a family operation, and Patel maintained the tradition, appointing relatives to important positions in the company. Freedom’s founder, Devaiah Pagidipati, was also a physician of Indian descent who had immigrated to the U.S. in the nineteen-seventies; his son, Siddhartha Pagidipati, a former investment banker known as Sidd, served as Freedom’s chief operating officer under Patel. Around the office, Patel was known as Dr. K. (Patel, Devaiah Pagidipati, Siddhartha Pagidipati, Freedom, and Optimum declined to comment for this article.)

Patel was a high-profile figure in the Tampa area, due, in part, to his prolific philanthropy. Tampa’s conservatory building bears his name, and his wife, who is a pediatrician, sits on the board of the city’s center for the performing arts. The couple has sent money to India to rebuild a village and to establish schools, and has donated large sums to local colleges—the University of South Florida includes the Patel College of Global Sustainability—and to hospitals and other health ventures. Patel has spoken publicly about having a skin-pigmentation disorder called vitiligo, for which he has chosen not to seek treatment. “I have the respect of society, and my wife tells me that people love me for who I am,” Patel told a publication called Florida Trend, in 2017.

Patel has gained particular notoriety for the private estate he is building in north Tampa, renderings of which have been printed in the local press. The residence will be a cross between the Taj Mahal and Versailles—a sixty-eight-thousand-square-foot palace with a fountain, a twelve-car garage, a Hindu temple, domed pavilions, and latticework made of red sandstone imported from Rajasthan. There will be separate buildings for Patel’s three grown children and their families, spread across seventeen acres that abut White Trout Lake, which is celebrated for its sunset views. The estate’s centerpiece is a grand ballroom.

At Freedom, it was clear to Sewell that Patel wanted to expand quickly and then sell the company, as he had with WellCare. He seemed to have ambitious goals, such as quadrupling the number of members within three years. According to Sewell, the internal philosophy at Freedom was to keep costs low, to move swiftly, and to be aggressive.

Medicare Advantage, on which Freedom’s business focussed, was part of a trend toward the privatization of health care. President Lyndon Johnson created the first national health-care program in 1965, after fierce political battles, when he signed the Social Security Act Amendments. The law established a fund to provide health-insurance coverage, known as Medicare, to Americans over the age of sixty-five, and to provide coverage to the poor through a sister program, Medicaid. “No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime so that they might enjoy dignity in their later years,” Johnson said at the signing ceremony, in Independence, Missouri, noting that eighteen million Americans were seniors, many with low incomes. “No longer will young families see their own incomes, and their own hopes, eaten away simply because they are carrying out their deep moral obligations to their parents, and to their uncles, and their aunts.” Johnson gave the first Medicare card to former President Truman.

There are currently sixty million seniors enrolled in Medicare, approximately eighteen per cent of the U.S. population, and the number is expected to rise to sixty-seven million by 2030. Medicare remains one of the most popular government programs. It has saved millions of people from financial ruin in old age, and, because of its importance to a crucial voting demographic, it has weathered decades of tax cuts and reductions to the social safety net. But the growing population of elderly Americans and the steep rise in the price of health-care services have spurred concern that Medicare could become insolvent; policymakers such as Paul Ryan, the former House Speaker, have argued that elderly citizens should receive vouchers to purchase health insurance on the open market, and there has been a push among certain lawmakers to privatize parts of the program.

Traditional Medicare is structured as a fee-for-service program: the government pays fixed amounts to doctors and other health-care providers for each service. The system is straightforward—the more health care you provide, the more money you are paid—but easy to abuse. Malcolm Sparrow, a professor at Harvard’s Kennedy School and the author of “License to Steal: How Fraud Bleeds America’s Healthcare System,” told me, “Under the fee-for-service system, the financial incentives were always to overutilize and overbill, and, if you were a crook, to fabricate claims.”

Medicare Advantage was supposed to mitigate the problem by harnessing the discipline of the private sector. In the nineteen-eighties, when health-care spending represented about nine per cent of the G.D.P. (the number is now eighteen per cent), President Reagan signed a bill that created an early version of the program. Medicare Advantage permits private health-insurance companies, including Aetna, Blue Cross Blue Shield, and United, to offer coverage to seniors under a new model: the companies receive a set amount of money from the government each month for each senior, and it is up to the companies to provide the prescribed coverage with the funds. “These were devices to make the health-care costs of the government more predictable and slower growing, and to shift the responsibility and accountability to a private entity whose entire well-being depended on prudent management,” Len Nichols, a professor of health policy at George Mason University, who served as a health-policy adviser during the Clinton Administration, told me. “Medicare Advantage is a long-standing part of the Republican strategy of privatizing Medicare.” The Advantage plans competed for patients with one another, and with traditional Medicare; they began offering perks such as health-club memberships, dental coverage, and rebates. And all this market competition would encourage better services and more preventive care, driving down costs. At least, that was the idea.

Around the time that Darren Sewell joined Freedom, his brother David was living in Ohio, working at G.E. Aviation. He was an expert in Six Sigma, a system for improving efficiency, originally developed by Motorola, and Sewell encouraged him to move to Florida and apply those skills to the health-care industry. David made a presentation to Sidd Pagidipati, the Freedom C.O.O., and was hired as a consultant. One of David’s first assignments was to improve the company’s growing backlog of client calls. (The C.M.S. closely monitors how long Medicare Advantage providers place members who call in on hold.)

I recently met with David at his home, in Tampa, where he lives with his partner, Sami, and two children, ages three and one. He is smaller than Sewell, athletic and tanned, with silvery hair and a sprinkling of stubble. He favors Florida-casual attire—khaki shorts and untucked button-down shirts—and seems to always have a stainless-steel canteen in his hand. He gets emotional when talking about his older brother, whom he described as fearless, the kind of person who would talk to anyone, and who frequently charmed women who seemed unlikely to pay attention to him. “It never ceased to amaze me,” David said.

When David first moved to Florida, the brothers were both single and lived fifteen minutes apart. They met for early-morning swims and made weekend trips to the beach with Sewell’s eight-year-old daughter, whom he had part time, in a shared-custody arrangement with a former girlfriend. The brothers talked about almost everything. One evening, Sewell told David that he had observed troubling practices at Freedom.

Sewell was the third-highest-ranking employee at the company; he helped lead the department that made clinical decisions and administered medical benefits to patients. He was privy to high-level corporate activity, and he sensed a general attitude of contempt toward the government. He believed that Freedom was intentionally rooting out sicker, more expensive enrollees by having sales agents target them and then encourage them to leave Freedom, an illegal practice known as “lemon-dropping.” He kept thinking of his grandmother, and how easy it would be for a salesperson to manipulate her.

To David, Sewell described the company’s behavior as “brazen”; he had already done significant research into the process of filing a qui-tam complaint. At one point, he jumped up, pulled a book from his shelf, and handed it to David. “You have to read this,” Sewell said. The book, by John W. Schilling, was titled “Undercover: How I Went from Company Man to F.B.I. Spy—and Exposed the Worst Healthcare Fraud in U.S. History.” Schilling had been a mid-level accountant at Columbia/HCA Healthcare, a multistate hospital chain co-founded by the former Florida governor (and now senator) Rick Scott, in 1987. In 1994, shortly after starting work at the company, Schilling became convinced that it was routinely overbilling Medicare. He filed a qui-tam case and became an informant for the F.B.I. The case proceeded in secret for several years, as the government gathered evidence. Scott resigned from the company in 1997, four months after the investigation became public, and began his career in Republican politics. Ultimately, his company paid $1.7 billion in criminal and civil fines and penalties to settle a long list of charges, and two executives were convicted of fraud and sentenced to prison.

Freedom was a much smaller enterprise, but Sewell felt that he had stumbled onto a similar case. He had already spoken with attorneys at Phillips & Cohen, the law firm that had represented Schilling. It seemed to him that each time the government’s health-care policies changed the private sector found new ways to maximize profit—even if, in some cases, it meant bending or breaking the rules. Medicare Advantage was just the latest example, and it was new enough that regulators and fraud investigators hadn’t yet figured out all the ways in which it could be gamed. Sewell’s imagination began to spin. “He loved James Bond movies. The aspect of wearing a wire really intrigued him,” David recalled. “There was one moment where he said, ‘Donnie Brasco’s got nothing on me,’ ” referring to an F.B.I. agent who infiltrated the Mafia and became the inspiration for a film.

David recalled asking, “How the hell are you going to be able to pay an attorney?” Sewell explained that reputable lawyers in qui-tam cases usually work on a contingency basis: they take only those cases which they believe are solid, and are paid if the case is successful, typically getting forty per cent of the whistle-blower’s award. He suggested that David file the suit along with him. David hesitated.

“I’m certainly more reserved and private than Darren was,” he told me. They talked about Patel; he was wealthy and well connected, and they couldn’t rule out the possibility that he or his allies would retaliate against them. “I had more concerns about the retaliation aspect,” David said. “This guy is held up in the medical community, the Indian community, he’s done this philanthropy stuff. He’s held in very high regard. For any individual to go against that, you’re not on equal footing.” David was also worried about exposing the rest of the family to a backlash if he and Sewell filed the case jointly. “If you’re already in this, and taking the fire, taking the bullets, is there value to me also coming under fire?” David said. “Not from a selfish standpoint. It was partly about the family—if he’s going to take all the fire for the family, do we really want others to come along?” David decided not to join the suit, and Sewell continued on his own.

Mary Inman, who is now a partner at the law firm Constantine Cannon, had spent ten years representing whistle-blowers when her firm flew Darren Sewell to San Francisco to meet with her for the first time, in 2008. Inman is petite and lively, with wide brown eyes and wild dark hair. She has a tendency to smile brightly, even when she’s about to deliver unwelcome news. Her colleagues refer to her as the “whistle-blower whisperer.” She talks about serving as an informal therapist and parent to her clients during the lonely, multiyear process of developing a qui-tam case. Part of the purpose of the initial meeting, she told me, is to “size up” the potential client, to figure out whether he or she is trustworthy. She asks herself, “Do I really want to spend the next six years with this person?”

Inman told me that, when Sewell walked into the room, she thought, “This guy is weird. He’s tall, he’s awkward, he’s got this eye thing going on.” But, she continued, “it sort of added to the mad-scientist bit. He was so impossibly intelligent.” She was soon won over by his self-deprecating humor, and described him as a “gentle giant.” Sewell told her that he believed Freedom was “cherry-picking”—recruiting healthy enrollees who needed little or no medical care—in addition to lemon-dropping. He said that the company had offered sales agents cash bonuses for getting seniors who required a lot of health care off Freedom’s insurance rolls. Inman told me that the behavior sounded “odious.” She said that, as the meeting with Sewell wore on, “it became very clear to me he knew exactly what he was doing. He was very intelligent and credible, and he knew he was in a fairly compromised position with some pretty questionable characters.”

While Inman and her associates debated whether to take the case, Sewell sent her documents that he said would show how the company tracked sick patients and targeted them for disenrollment. He also shared a photograph of a conference table that Patel had installed in the office. The table was enormous, with a gleaming marble top. The faces of Patel, his wife, and his father were carved down the center and into the base, in a manner reminiscent of Mt. Rushmore.

Inman also did her own research, which revealed that Patel’s first company, WellCare, had been raided by the F.B.I. several years after he sold it, during a Medicaid-fraud investigation; WellCare executives were eventually indicted, in 2011. Its former general counsel was later sentenced to six months in prison, and the company paid two hundred and twenty-seven million dollars to settle civil and criminal charges. (Patel was not implicated in the case.) Inman found Sewell refreshingly honest about the appeal of the potential financial rewards. “He was human,” she said. “I told my partners, ‘I like this guy, we’re going to bet on him. It may not turn into anything, but we’ll try.’ ”

In a qui-tam case, a complaint is filed by the whistle-blower in secret, under seal, so that the government can conduct its own investigation without alerting the target. If federal prosecutors find the allegations credible, the Justice Department may decide to sign on as the lead plaintiff, which gives the case added heft and credibility. (The whistle-blower can also move forward on his or her own if the government declines.) Inman warned Sewell that being a whistle-blower would take a personal toll. He wouldn’t be able to talk about the case with anyone but his attorneys. Once the suit became public, he might be branded a traitor in the business community and have trouble finding another job. It would be lonely and stressful. But Sewell said that he wanted to proceed.

For several months, Sewell went to work as he normally did. When he came home, he began his second shift, e-mailing spreadsheets and documents to Inman from his Gmail account and then spending hours on the phone with her, explaining what they meant. There was a sense of time pressure; if a different Freedom whistle-blower filed a complaint first, Sewell might not be able to participate in the resulting case. On August 17, 2009, he finally filed his complaint with the district court in Tampa, alleging that Freedom was manipulating enrollment rolls. The complaint also alleged that Freedom was engaging in service-area-expansion fraud—misrepresenting the number of health-care providers in its network in certain counties, so that it could expand the areas in which it offered Medicare Advantage. Sewell and Inman filed hundreds of pages of supporting documents, including internal e-mails, spreadsheets, and marketing files. Then they waited for a call from the U.S. Attorney’s office, which came a few weeks later.

Randy Harwell, the chief of the civil division at the U.S. Attorney’s office in Tampa, told me that the biggest challenge his office faces when assessing a new complaint is determining the whistle-blower’s motives and figuring out whether there are inconsistencies in the story. “This is the busiest whistle-blower docket in the country,” Harwell told me. “We get all kinds in this office—crusaders, people who are just really upset, people who are just crooks themselves, frankly. It’s not uncommon at all for complete grifters to come in and pitch cases.” But Sewell, he said, was credible from the start. Sewell and Inman eventually presented fifty PowerPoint slides of evidence to Harwell and a group of other investigators. “All of life is a bell curve, and the whistle-blower docket is certainly a bell curve, and there’s wheat and there’s chaff,” Harwell said, and added that he remembered Sewell “being a very squared-away, knowledgeable guy. It seemed like he knew what he was talking about.”

The next step was the government’s investigation. For more than a year, Sewell led a double life as an undercover agent, helping the government build its case. He became accustomed to a gruelling routine. Before work, he would meet Ed Ortega, the F.B.I. agent, in various parking lots—sometimes at a Catholic church or a motel, other times next to a Bank of America. Ortega would outfit Sewell with the wire. Then Sewell would go to work and record. A few hours later, he’d slip out to meet Ortega again to return the device, hoping that no one would notice his absence. It was critical that Sewell not discuss the investigation with anyone; if the seal was broken, Sewell was repeatedly warned, his role would be imperilled and he could get nothing. The only person potentially excluded from the circle of silence was a spouse; because Sewell wasn’t married, there was no one he could talk to.

In 2010, while the investigation was under way, Sewell was moved to a different job at Freedom, in the Medicare-revenue-management department, where he reported to an executive named Mital Panara. In his new role, Sewell was exposed to a different side of the business, including the risk-adjustment department, which assigned Medicare Advantage enrollees codes that reflected their diagnoses. Certain codes and combinations of codes led to larger reimbursements from the government, and it was simple, with modest computer-programming skills, to figure out how to generate the most profitable codes based on the group of patients you had. Of course, companies were supposed to apply codes only to patients who actually had the corresponding conditions, as determined by a physician who had treated the patient.

Sewell quickly noticed many coding inaccuracies, almost all of which were in the company’s favor, resulting in higher government payments. Sewell believed that Freedom was committing risk-adjustment fraud—instructing its internal coding auditors to scour medical records for places where the codes could be amplified, a practice known as “capturing” codes. Sometimes, he later alleged, Freedom pressured doctors to schedule unnecessary appointments and to assign additional codes that the internal data miners thought would be more profitable.

Sewell also saw further evidence of the service-area-expansion fraud: Freedom was “renting” groups of doctors in various counties in order to gain C.M.S. approval to expand, and then dropping the doctors after receiving it. In one example that Sewell found, Freedom said that there would be six in-network oncologists in Duval County, a large county in Florida, but patients couldn’t find a single one. The company’s strategy seemed to be paying off: in 2009, Inc. named Freedom one of America’s fastest-growing companies.

Sewell’s case was one of the first to show prosecutors and attorneys how Medicare Advantage could be defrauded. When, in January, 2011, a prospective whistle-blower named Benjamin Poehling contacted Inman’s law firm, Inman instantly understood what his allegations meant. “It was because of Darren that when Ben called me I was able to appreciate the gravity of what he was saying,” Inman told me. “Darren was our origin story of risk-adjustment fraud.”

Poehling grew up in Bloomington, a suburb near Minneapolis. His father was a high-school social-studies teacher who also sold residential real estate, and his mother was a stay-at-home mom. “My parents always surrounded me with positive role models,” Poehling told me recently. He attended a Catholic high school, and the family went to church every Sunday. He began playing golf at an early age, and the game helped shape his moral outlook. “Golf is a unique sport—you’re your own referee,” Poehling said. “One of the first times my dad introduced me to golf, he said, ‘Look, Ben, golf is very different from other things in life. No one is policing you. You are writing down your own scores. You’ll have multiple opportunities to cheat.’ His one rule was that you always follow the rules.”

Poehling graduated from Drake University, in Iowa, in 1998, with a degree in actuarial science and finance, and then joined Arthur Andersen, a multinational accounting firm, as a consultant. In 2002, Arthur Andersen, which was embroiled in the Enron scandal, split apart. Poehling went to work for a subsidiary of UnitedHealth Group, which had been one of his clients at Arthur Andersen. (United’s current and former C.E.O.s are also alumni of Arthur Andersen.) Around the time that Sewell joined Freedom, Poehling was working with United’s risk-adjustment and Medicare Advantage teams.

I met with Poehling in Bloomington, where he lives with his wife and three young children. He said that, over time, he realized that it wouldn’t be difficult to steal from Medicare Advantage. “The risk-adjustment system, it’s essentially an honor system,” Poehling told me. “It’s very similar to golf.”

Poehling was disturbed by what he described as a chart-review program at United, in which the company systematically went through hundreds of thousands of medical records, searching for places to increase the diagnosis codes in order to make patients appear sicker. In some cases, legitimate codes had been left out and needed to be added. But, according to Poehling’s allegations, the system was set up primarily to find opportunities for increases, and designed not to delete inappropriate codes. United had an aggressive internal culture, he said, with bonuses for executives who raised reimbursement numbers. In a 2007 e-mail provided to the Justice Department, the former C.F.O. of the group that managed United’s Medicare Advantage plans wrote to an executive at a data-analytics subsidiary, “Wanted to get together with you and discuss what we can do in the short term and long term to really go after the potential risk scoring you have consistently indicated is out there. . . . You mentioned vasculatory disease opportunities, screening opportunities, etc with huge $ opportunities. Lets turn on the gas! What can we do to make sure we are being reimbursed fairly for the members and risk we take on more than what we are currently doing.”

Poehling said that he briefly considered quitting his job, but decided that that would be unprincipled. He mulled over his other options. He could raise his concerns with United’s board of directors, but there was no way to be sure that they would take action. He could send an anonymous complaint to the C.M.S., but he didn’t know if the agency had the resources to pursue his case. (The limited C.M.S. budget can make it challenging for the organization to police fraud.) Filing a qui-tam complaint was personally risky, but at least it insured that the allegations would be investigated. “I’m sitting in this situation, and I don’t know if what United is doing is illegal or not. I’m not a lawyer,” Poehling said. “But it went against all the principles I had been taught and had lived by my entire life.”

Poehling said that the size of the alleged fraud made the matter urgent. “I would not have done this if this were a ten-million-dollar issue or a five-million-dollar issue, or if it were just limited to one part of the company,” he said. “But that wasn’t the case. This was potentially a multibillion-dollar issue. The scale of it was huge. And this was known for many years at the highest levels at the largest health-care company in this country.” (In a statement, a UnitedHealthcare spokesperson wrote, “Our company followed the Medicare Advantage program rules, and has been transparent with the government about our approach.” The spokesperson added that the C.M.S. “has continued to accept our bids and pays us under our contracts.”)

Poehling spent the next several months collecting documents and evidence, and, on March 24, 2011, he filed a qui-tam complaint.

In the summer of 2010, Freedom hired a nurse and coding specialist to conduct a mock audit of its diagnosis data in order to prepare for a possible audit by the government. According to evidence that Sewell gathered, the specialist found that approximately eighty per cent of the diagnosis codes in the company’s records were unjustified—a shocking number. When the specialist reported the results to Panara, Sewell alleged, he asked her to assess the codes more “leniently.” (Panara denies this.) Medicare regulations dictate that Freedom should have reported the invalid codes to the government and reimbursed it for millions of dollars in overpayments, but, according to Sewell, the company never did so. (In a statement, Panara’s lawyer wrote, “Panara did nothing to violate the False Claims Act or any federal regulations,” adding that he “Admitted no wrongdoing and suffered no personal penalties” in the case.)

After more than ten months, the government prosecutors were still unsure whether they had sufficient evidence to join Sewell’s case. They kept asking him to get more. “He liked the cloak-and-dagger stuff,” Inman told me. “At the start, everyone is kind of flattered. It’s kind of exciting. He would joke about it, humor was his device.” But, as the investigation dragged on through 2011 and into 2012, the novelty wore off and the stress started to weigh heavily on Sewell. He worried that Freedom would discover his actions and blacklist him in the industry, and that the legal case would fall apart. He also worried that he would implicate innocent or lower-tier employees through his indiscriminate taping. He became increasingly short-tempered and distracted. “Some days, you could just see the stress on him,” David said. “When he was under stress, his eye would deviate. I saw him every day, and I could tell something was going on.”

Even Ortega seemed frustrated by the government’s lack of momentum. Finally, in the spring of 2012, in a bid to move the investigation forward, Ortega decided to approach Panara and attempt to persuade him to flip. It was a risky move—if Panara said no, he might alert the rest of Freedom’s senior management to the investigation.

Ortega approached Panara after a conference and confronted him with comments that Sewell had recorded—comments that, from their context, likely made it clear that Sewell was the government’s source. Panara refused to coöperate.

The government rushed to send subpoenas to Freedom. Finally, two and a half years after Sewell had launched the case, Freedom executives knew that they were under investigation. The next day, Patel called an emergency meeting and instructed employees not to destroy documents or other evidence. Then Freedom launched its own inquiry into the fraud. Inman told me that this type of internal investigation is often intended in part to identify which employees, if any, have been coöperating with the government. (The law prohibits companies from retaliating against whistle-blowers, but punitive actions are nevertheless common.) Company attorneys began interviewing employees. When it was Sewell’s turn, he declined to answer certain questions, and instead responded as Inman had coached him: “I want to help you. I’m a coöperating witness in a federal investigation. And I’m represented by counsel.”

It would have been imprudent for Freedom to fire Sewell, but the revelation that he had become a whistle-blower marked the beginning of a swift and painful series of events. Within a few days, according to allegations in his complaint, Sewell was locked out of his office computer. His access was restored, but a few days later he discovered that his personal laptop had disappeared from his bag while he was out of his office for a few minutes. Sewell panicked. Anyone in the Freedom office could have taken the computer, which likely contained many of his communications with his lawyers, and also the presentation that he and Inman had given to government prosecutors. The laptop was never recovered.

In April of 2012, Freedom placed Sewell on administrative leave; in September, he submitted his “involuntary resignation.” Later that fall, while he was at home looking for a new job, Sewell heard that his former employers were telling others in the industry to avoid working with him. Former colleagues also told Sewell that Freedom executives had claimed that he was responsible for the fraud—that he had filed the whistle-blower complaint to punish the company for failing to promote him.

It was no surprise, then, when Sewell had trouble finding a new position in the clubby Florida Medicare-insurance industry. Each time he seemed close to getting an offer, the job would suddenly fall through. Sewell resisted the idea of moving out of the state, since he wanted to stay close to his daughter. And the government still hadn’t made a decision about whether to join his case. Everything was on hold.

In a paper published in The New England Journal of Medicine, in 2010, a group of researchers studied how the qui-tam process affects whistle-blowers in major health-care-fraud cases. The study’s subjects reported feeling intense pressure while coöperating with the government, and said that the cases created high workloads. They expressed frustration with how slowly the investigations moved and with how little information prosecutors shared with them. They reported anxiety and uncertainty that lasted for years, and some spoke of being threatened, of losing their jobs, and of being blocked from new employment.

A few of the comments were particularly telling. One interviewee, in response to a question about what advice he would give a potential whistle-blower, wrote, “[Can they] afford 5 years of their life in turmoil?” Another said, “Part of your ability to do anything about this is keeping yourself together,” and suggested that whistle-blowers find someone “like a minister or a shrink who’s confidentiality-protected,” because “this could go on for a while.” A high proportion of whistle-blowers reported divorces or other marital strain, family conflicts, and stress-related health issues including shingles, autoimmune disorders, panic attacks, insomnia, and migraines. Several of them said that the financial consequences were devastating. “Honestly, I would not advise anybody to do it,” one said.

In mid-2013, Sewell was still without a steady income, and he had begun digging into his savings to pay the bills. “He was going broke,” David told me. “He liquidated I.R.A.s and his retirement accounts.” He became increasingly depressed; he gained weight, then lost it again. Inman recalled telling Sewell, one night on the phone, about the severe postpartum depression that she had experienced. “I know what you’re going through. I’ve been at the bottom of the well,” she told him. “I’m asking you—as your lawyer and your friend—you need to stay with us.”

Sewell’s fortunes appeared to take a turn when he was hired as a consultant by a midsized physicians’ group. But, a few weeks into the job, he was told, with little explanation, that the position had ended and that he should leave. Sewell was devastated. He felt certain that his former employers had learned about his new job and intervened. “It felt like there was an optimism there,” Inman said. “And, when it happened again, it was different. You could just see, it was defeatism. And I just felt like that was it.”

“That was the one that really just crushed him,” David said. Sewell told other family members, “They got me. They got me good this time.” David suggested that the two of them go on a beach vacation or a fishing trip, so that Sewell could think about something else. Sewell agreed that that was a good idea.

A few days later, in early September, 2014, Sewell was rushed to the hospital with a serious head injury after an accidental fall inside his house. Medical personnel found a clot in his brain. After three days in the hospital, Sewell died, at the age of thirty-nine.

Amid the shock and grief, David was informed that, as the executor of his brother’s estate, he would have to take Sewell’s place as the whistle-blower in order for the Freedom case to proceed. He was stunned to learn the extent of what Sewell had uncovered. David was planning to get married, and he had concerns about taking on such powerful adversaries. But, if he didn’t do it, the case would be terminated, and everything Sewell had gone through would be for nothing. There was very little left in Sewell’s estate for his daughter—except, potentially, his portion of the fraud recovery. David agreed to stand in as the whistle-blower.

According to Malcolm Sparrow, of Harvard, unchecked fraud could lead to the wholesale destruction of government health-care programs. Systemic theft creates cost inflation, he explained, which increases political pressure to make cuts, often affecting both the healthy and the unhealthy parts of a program. “That’s going to translate in one way or another to less medical treatment when it’s needed, and clear incentives for the insurance companies to provide poorer-quality care,” Sparrow said. “Indiscriminate cost cutting hurts the honest people more than the dishonest. If you just cut reimbursement rates, they’ll just bill more. They’re not constrained by the truth.” If politicians don’t learn to discriminate between fraud and legitimate activity, Sparrow warned, “this will grow like a cancer and destroy your program.”

In February, 2017, the government announced that it was joining Benjamin Poehling’s case against United. United has denied the charges and is fighting vigorously against them in court. The company filed a motion to dismiss the case, and, last February, a judge granted the motion for some of the claims but allowed a central allegation—that United had failed to correct diagnosis codes that it knew were false—to move forward. In its defense, the company cites a principle known as actuarial equivalence, which requires that the government treat Medicare and Medicare Advantage plans equally. United argues in court filings that the C.M.S. “does not delete or otherwise account for the unsupported diagnosis codes . . . when it is calculating risk scores for its traditional Medicare enrollees,” and that, as a result, requiring Medicare Advantage plans to delete unsupported codes without making traditional Medicare do the same violates actuarial equivalence.

Poehling left the company in 2012, before the case became public, and feels fortunate to have found another job. After our interview in Bloomington, Poehling and I took a drive. We circled United’s headquarters, a cluster of mirrored buildings in Minnetonka, just west of Minneapolis. We also visited Edina, an affluent area where many United executives live. We passed country clubs and grand houses surrounded by rolling lawns. It was late fall, and the streets were blanketed in golden leaves.

Poehling noted that United’s stock had performed spectacularly in recent years. “If you ask any health-care executive now, one of the driving forces in their business is government health-care programs,” he said. He seemed dubious that Medicare Advantage was working as intended. “A lot of enrollees get free gym memberships, free dental care. They get all these things you don’t get with fee-for-service Medicare. When people say, ‘Well, how do these private companies do it, how do they fund it?’ Well, this is how they fund it!” he said. “The fundamental question is, does Medicare Advantage really save the government money?”

In 2016, seven years after Darren Sewell filed his case, the Justice Department informed Inman that it would join the suit. In May of 2017, after months of difficult negotiations, Freedom settled charges that it had violated the False Claims Act and agreed to pay $31.7 million. Freedom’s former chief operating officer, Sidd Pagidipati, paid seven hundred and fifty thousand dollars to settle charges related to his role in the alleged service-area-expansion fraud. Neither admitted liability. The whistle-blower’s share of the recovery, $6.4 million, will be split between Sewell’s estate and his attorneys. The company paid another $2.3 million for Sewell’s attorneys’ fees. Inman recently moved to London, which is a top source of American whistle-blower lawsuits outside the U.S., to build a new practice for her firm there.

Five months after the Freedom settlement, Patel announced that he was selling Freedom’s parent company to Anthem, the second-largest insurance firm in the country, reportedly for more than a billion dollars. That year, Florida Trend named Patel “Floridian of the Year.” He told the publication that he was planning to dedicate his time to philanthropy. When asked about the Freedom fine, he responded, “I decided to take it as a cost of doing business.” ♦