Specific Examples of False Claims Act Fraud

According to the TaxPayers Against Fraud Education Fund, common types of medical related fraud and other frauds that have led to False Claims Act recoveries include:

  • Billing and finance:
    • Drug billing fraud
      • Billing for non-FDA approved drugs or devices
      • Billing for brand — billing for brand-named drugs when generic drugs are actually provided
      • Billing for unlicensed or unapproved drugs
      • Unbundling – Submitting multiple billing codes instead of one billing code for a drug panel test in order to increase remuneration
    • Employee billing fraud
      • Phantom employees and doctored time slips: charging for employees that were not actually on the job, or billing for made-up hours in order to maximize reimbursements
      • Upcoding employee work: billing at doctor rates for work that was actually conducted by a nurse or resident intern
    • Billing for work not performed or work not contracted for
      • Billing for goods and services that were never delivered or rendered
      • Billing for work or tests not performed
      • Billing for marketing, lobbying or other non-contract related corporate activities
      • Billing for research that was never conducted
    • Improper billing for work partially or fully performed
      • Double billing – charging more than once for the same goods or service
      • Being overpaid by the government for sale of a good or service, and then not reporting that overpayment
      • Shifting expenses from one fixed-price contract to another
      • Billing for premium equipment but actually providing inferior equipment
      • Billing in order to increase revenue instead of billing to reflect actual work performed
      • Bundling — billing more for a panel of tests when a single test was asked for
      • Upcoding – Inflating bills by using diagnosis billing codes that suggest a more expensive illness or treatment
      • Falsifying research data that was paid for by the U.S. government
  • False evidence, false records, false results
    • Testing
      • Presenting broken or untested equipment as operational and tested
      • Defective testing – certifying that something has passed a test, when in fact it has not
      • Automatically running a lab test whenever the results of some other test fall within a certain range, even though the second test was not specifically requested
    • Product performance
      • Failing to report known product defects in order to be able to continue to sell or bill the government for the product
      • Submitting false service records or samples in order to show better-than-actual performance
      • Falsifying natural resource production records — pumping, mining or harvesting more natural resources from public lands that is actually reported to the government
      • Misrepresenting the value of imported goods or their country of origin for tariff purposes
    • Additional misrepresentations
      • Performing inappropriate or unnecessary medical procedures in order to increase Medicare reimbursement
      • Forging physician signatures when such signatures are required for reimbursement from Medicare or Medicaid
      • False certification that a contract falls within certain guidelines (i.e. the contractor is a minority or veteran)
      • “Lick and stick” prescription rebate fraud and “marketing the spread” prescription fraud, both of which involve lying to the government about the true wholesale price of prescription drugs
  • Kickbacks
    • Illegal marketing of prescription drugs and devices through kickbacks
    • Winning a contract through kickbacks or bribes
    • Prescribing a medicine or recommending a type of treatment or diagnosis regimen in order to win kickbacks from hospitals, labs, or pharmaceutical companies

How Our Law Firm Can Help

We can identify the type of fraud involved
We can help prove the fraud
We can pursue the fraud claim in the appropriate courts

Our Firm’s Experience

The attorneys of Begelman & Orlow, P. C. have offices in Cherry Hill, New Jersey and Conshohocken, Pennsylvania. We handle claims across the United States. Contact our offices at 866-627-7052. We have 115 years combined experience protecting your rights in all phases of whistleblower, qui tam and False Claims Acts law.

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