Phillips & Cohen Evidentiary Data Scientist George Collins

Affiliates of Kaiser Permanente last month agreed to pay $581 million to the federal government to settle multiple whistleblower cases alleging that the companies engaged in “risk adjustment” fraud and other misconduct. 

Phillips & Cohen brought one of the lawsuits in 2014 on behalf of a whistleblower client under the qui tam provisions of the False Claims Act. 

“This remarkable outcome highlights the scope and significance of health care fraud and the importance of whistleblowers in recovering money that should be going to patient care and affordability instead of the pockets of health care companies,” said George Collins, senior counsel and evidentiary data scientist with Phillips & Cohen.

Some of the Kaiser defendants had contracts with the Centers for Medicare & Medicaid Services to provide healthcare as Medicare Advantage organizations, also called Medicare Part C. 

Under the MA program, the government pays Medicare Advantage plans a fee to cover medical services for plan members. That fee is “risk adjusted” based on each member’s health status, age, and other factors that could affect the need for more or fewer medical services. 

Medicare Advantage payments are based in part upon the health plans’ submission of diagnostic codes concerning health conditions with which their the plans’ beneficiaries were diagnosed during the year. 

When the plans’ beneficiaries are diagnosed with certain serious health conditions, the government increases its payment to their insurers.

The Phillips & Cohen lawsuit identified multiple categories of diagnosis codes which consistently had extremely high error rates. 

For example, patients who had a prior history of cancer were often miscoded as if they had active cancer, which caused the government to make significantly higher payments to the defendants. 

The complaint alleged that the companies failed to take appropriate corrective action, which would have required refunding the prior overpayments and giving up their inflated revenue going forward.

George Collins’ practice is focused on two types of whistleblower cases: data-centric cases in which large, complex datasets provide primary evidence of fraud, and software-centric cases in which software is either the subject of fraud or used to commit it. 

Collins is fluent in multiple programming languages and draws on diverse analytical methods – including machine learning, natural language processing and complex systems modeling – to address challenges that arise at all stages of a case.

In 2024, Collins helped secure a $90 million settlement in a whistleblower case against Humana, Inc. for allegedly submitting fraudulent bids to operate a Medicare Part D plan. 

Collins helped achieve a $108.75 million settlement with KBR for allegedly defrauding the United States Army in connection with KBR’s contract to supply troops in the Iraq War with property and materials.

Collins received his law degree from Yale Law School and concurrently received a Masters of Environmental Management from the Yale School of Forestry and Environmental Studies. During his joint-degree program, Collins focused on the intersection of data analysis, statistical modeling and legal and policy concerns.

What is your practice at the firm?

“My background is fairly deep into computer programming, algorithms, data analytics,” Collins told Corporate Crime Reporter in an interview last week. “That puts me on a lot of our technical cases – cases related to fraud effectuated by computers or people using computers. The majority of my practice is in healthcare, but also government contracting, customs, high frequency trading. If there is going to be a large data set brought to us by a potential client, or during discovery, I’ll be working with that internally or with outside experts.”

“I specialize in our in-house capacity to work on large data. It’s a satisfying practice. I’m not aware of this setup existing in other firms. I think it must, but I’ve never run into it.” 

You are an evidentiary data scientist. When a corporate defense firm turns over a warehouse full of documents in discovery, your job is to make sense of it?

“The era of dumping of documents is still with us. And yes, a warehouse full of uncopyable documents, repetitive email chains. This vast volume of digital documents is booked under the header of e-discovery.” 

“I work on something quite different. Sometimes I will dip into that world when needed. Most often what I’m dealing with is the dumping of 800 gigabytes of structured data. That could be the entirety of a company’s internal database. That could be fifteen years of point of sale transactions for a national pharmacy. That could be every single aspect of a company’s supply chain in a customs case or a military contracting case.”

“That lands on us and we often don’t have any documentation. We are not sure if the production is complete. And I specialize in going in and working with that evidence the same way an e-discovery specialist works with ten million emails. I’m dealing with structured data. That could be billions of lines of structured data.” 

“Fortunately, computers are very fast and I have had the good fortune to be programming for a while. So I’m able to make it work.”

“Traditionally this work has been outsourced to external consulting companies. What my colleagues and I try to do is think of that data as another source of evidence, not just in terms of a damages analysis, but also as central evidence often of liability in the case itself, structure a legal strategy around it, consider how it relates to every other piece of data in the case. And then we can do with it what we want internally and as we need to, we can have a much smoother transition in moving with an external firm because we already understand what the data says internally.”

What’s the value of artificial intelligence to your work?

“I have what will seem like a crotchety old fashioned view of this. One of the problems with the term AI is that it is often deliberately undefined in the modern marketplace. Let’s look at machine learning, which is an outgrowth of classical statistics applied to computation at scale – I use that all the time. I have written custom algorithms. It’s a great pleasure to be working in that structured and disciplined field. That is an important part of my work.” 

“Sometimes there is no substitute for going in, and with human eyes, looking at a bunch of different cases, considering how they relate to each other and then writing heuristics that can classify them. But when it comes to generative AI, which is usually what people mean when they speak of AI, I don’t really have a place for that in my work.”

“And I don’t mean to dismiss it out of hand across the whole legal industry. I am more often writing code than I am writing legal documents. The generative part of generative AI simply means that it’s able to produce something that’s convincingly like a legal document, or convincingly like a chat response or convincingly like a picture.”

I was talking with a criminal defense attorney a couple of weeks ago and he was telling me that AI is helpful to him for picking out nuggets of information that he can use in his case.

“And there is probably more of an application for that in the context of a million emails than a billion lines of data. I can analyze the billion lines of data quite precisely in exactly the way that I want to. I’m usually writing an extremely precise specification for the pattern that I’m looking for and then refining that.”

When the whistleblower shows up at the firm, does the whistleblower show up with a cache of corporate documents?

“Sometimes.”

And are you brought in to make a judgement as to whether the documents are meaningful?

“If the case touches on a complex technological topic. Particularly in a cybersecurity case, a case involving generative AI, I’ll often come in and review the technical merits of the claim. That might involve a review of documents. But people often come in with nothing but what they know or what they’ve heard. And we can assess the case with or without documents. Documents can obviously be helpful, but they are not necessary.”

Do you have a sense whether all of these fraud cases being revealed by this False Claims Act litigation is having any deterrent impact? Or are we just scraping off the top of a giant iceberg?

“The cases are definitely having an impact. What’s under the water? It’s hard to say. And we’ll find out if more brave people come forward with more information about new strategies that these companies are adopting. But generally speaking, whole areas of fraud have been largely stamped out or at least it’s made it much harder to convince a group of people in a company to move forward with it.” 

“As we were talking about with defense contracting, a sector of an industry is going to some extent stop doing certain things and to another extent refine what they are doing or change its approach.”

“There are certain kinds of cases that we are not seeing anymore and that’s because the industry has determined that it is too risky.”

There have to be slam dunk whistleblowers who when they walk in the door, the attorneys say –  okay, we’re going to take it. What are the indicators of a quality whistleblower?

“A few things come to mind. A whistleblower that knows something about decisions made inside the company and why. They know something about the company’s concern over the legality of that decision and are aware of internal attempts to override that decision. That’s very important information for us. But sometimes the mere fact of the practice is enough for us to want to continue investigating and considering taking it on. But when someone comes in with information about what the company actually knew, that can be valuable. That’s the kind of information that’s difficult for an outsider to ever get to or for the government to get to once they start investigating and people get cautious and clam up.”

“These aren’t cases of corporate negligence. They are cases about fraud which requires a higher standard. We need to be able to show that standard when we bring a case forward. Sometimes you can infer it. But that information can be helpful.”

“In cases that are going to be data heavy, it is helpful if someone has access to that data, as long as they got it in the ordinary course of their work. We don’t ever want people to go rooting around in company systems that can get everybody into a lot of trouble. But if someone is working with data in the course of their job and realizes that something is based on the data and they can bring even part of it forward to show us, if I can do the analysis and we can look at it collectively and think – yes, this is part of the evidence that can make the claim, that can be helpful.”

“Another cartoon about whistleblowers is that they are often disgruntled employees or former employees. And certainly there are employees or former employees who have been treated extremely unfairly by companies and we take that into account. But a fairly common situation is – we see a whistleblower who believes in the ability of the company to do some good socially and finds out that the company is not living up to its promises or its mission or the image that the employee had of what the company was or what the company could do. I wish the company would do the right thing and then we could help take care of sick people instead of ginning up fake diagnostic codes and sending the money up to the C-suite. That’s a pretty common pattern.”

“I have had the good fortune to work with a few whistleblowers who exemplified that sense of – why is the company acting this way when it could be doing good for the world?” 

Do you know how many billions of dollars a year we lose to health care fraud every year?

“The number that we don’t know about is a lot larger than the number that we know about. But it is truly massive.” 

There is a Harvard professor – Malcolm Sparrow. And he put the number at between $100 billion and $500 billion a year. What do you think the number is?

“All I can say is I believe that number or a higher number is absolutely possible.”

What part of the firm’s practice involves health care fraud?

“It is significant and it has been since the beginning. There are a lot of emerging areas like customs fraud. But healthcare fraud is going to remain a major area.”

Even if the government decides not to join a False Claims Act case, the whistleblower can still proceed with the case on behalf of the government.

“True. In Kaiser the government joined the case. Even when the government declines cases, the government is also closely involved.”

Tell us about those cases, where the government declines to join but remains involved.

“The first thing that is maybe not clear unless you have worked the practice for a while is that declination can happen for a lot of reasons. A very typical reason is simply lack of immediate resources. Another is the government’s confidence in the relator firm to take the case forward. The government will say – we don’t think we need to be involved, we believe in this case, we think you’ve got it and we are too busy with other matters. That would be a declination. So a declination is by no means a lack of belief in the merits of the case. It could be a righteous case from the government’s perspective.” 

“There is also a very complex set of circumstances involving seal extension. There are times when the government, often for resource reasons, hasn’t been able to move a case along quickly enough and the case ends up coming out from under seal before the government is ready to intervene, at which point it is de facto up to the relators to take it forward. But it remains a close collaboration in many cases. It’s ultimately the government’s interest that is at stake in the case. They have the power to try and come in and try to quash a case formally or informally.” 

“If the government doesn’t want a case to move forward, there are a lot of ways they can pursue that. There are cases where there was a declination for one of several reasons and then near the end of the case the government was considering intervening again. The government has the option to intervene later in the life cycle as well.” 

“It’s very specific case by case. In some cases, defense counsel will try and characterize a declination as a statement that the case should be dismissed. And in my experience, it is often anything but that.”

[For the complete q/a format Interview with George Collins, 40 Corporate Crime Reporter 6, February 9, 2026, print edition only.]