What Kinds of Fraud are Actionable Under the False Claims Act?

The False Claims Act covers basically any claim for payment or money owed to a federal program, except for taxes. Over the last decade, most recoveries under the False Claims Act have been for claims in health care (Medicare, Medicaid, Tricare, Federal Employee Health Benefits Program, and VA), defense spending (Department of Defense), and banking (Fannie Mae and Freddie Mac); as well as dealings with the Small Business Administration, for-profit universities, customs duties, and energy grants.

What are some examples of health care fraud?

Many different kinds of wrongdoing qualify as fraud that allows a recovery under the False Claims Act but to be actionable under the statute, the fraud must involve payments by a federal program (such as Medicare, Medicaid, Tricare, the VA, or the Federal Employee Health Benefits Program). Robins Kaplan attorneys have successfully tried health care fraud False Claims Act cases in the following areas:

  • Kickbacks (providing someone something of value in order to convince them to refer a patient)
  • Ambulance transport fraud (billing for transport that wasn’t necessary, or for more miles than were actually travelled)
  • “Up-coding” fraud (billing for a more expensive medical service than what was performed)
  • Home health care fraud (billing for services not provided)
  • Hospital fraud (for example, billing as in-patient services that should have been performed out-patient)
  • Laboratory fraud (for example, giving away free services to attract more referrals or billing for unnecessary tests)
  • Long term care and skilled nursing facilities fraud (for example, billing for rehabilitation services that were either not provided or not necessary)
  • Pharmaceutical fraud (for example, marketing a drug for an unapproved – “off-label” – use, or paying doctors to prescribe a drug)
  • “Stark Law” violations (referring patients for services where the referring physician or practice has a financial interest)

If you suspect that health care fraud is being committed and wish to take action, we can help.

For a free case evaluation, please contact us at 1.888.563.1378 (toll-free) or fill out the form to the right. We handle cases in all 50 states.