Healthcare/Medical Fraud

Healthcare fraud is rampant in this country, and one of the primary bases for False Claims Act cases.

Healthcare/medical fraud can take many forms:

  • Billing for services not rendered
  • Billing for more expensive services than were actually performed
  • Performing more expensive services than were medically necessary
  • Misrepresenting the diagnosis to justify payment
  • Creating false documentation to support payment
  • Billing under the provider number of a different doctor than actually performed the procedure
  • Performing medical procedures without a physician supervising
  • Backdating procedures for a time the patient was insured
  • Kickbacks and Stark Law violations
  • Billing for “overflow” of medicine
  • Off-label marketing of pharmaceuticals

These are just some of the possible claims; there are an endless number of possibilities, with new creative ways to defraud the Government coming out every day.

Medical fraud under the FCA can be against any federal or state provided health insurance, including Medicare, Medicaid, TriCare, Department of Veterans Affairs, federal employee insurance, Railroad Medicare, and Obamacare exchanges.

Even if you are only aware of fraud against private insurance, it is likely the fraud extends to other federal insurance as well, and you should contact us to discuss whether you have a potential FCA claim.