False Claims Examples
The False Claims Act also imposes liability on an individual who may knowingly submit a false record in order to obtain payment from the government
An example may be a physician who submits a bill to Medicare for medical services they know they have not provided.
Another area of liability includes those instances in which someone may obtain money from the federal government to which he may not be entitled, and then uses false statements or records in order to retain the money.
An example of this so-called “reverse false claim” may include a hospital who obtains interim payments from Medicare throughout the year, and then knowingly files a false cost report at the end of the year in order to avoid making a refund to the Medicare program.
While it is impossible to list succinctly all of the fraud schemes that have been prosecuted under the False Claims Act, the following list gives some idea of the scope of the frauds that have been uncovered to date:
- Billing for goods and services that were never delivered or rendered.
- Double billing – charging more than once for the same goods or service.
- Billing for marketing, lobbying or other non-contract related corporate activities.
- Submitting false service records or samples in order to show better-than-actual performance.
- Presenting broken or untested equipment as operational and tested.
- Shifting expenses from one fixed-price contract to another.
- Illegal marketing of prescription drugs and devices through kickbacks.
- Billing for non-FDA approved drugs or devices.
- Performing inappropriate or unnecessary medical procedures in order to increase Medicare reimbursement.
- Billing for work or tests not performed.
- Billing for premium equipment but actually providing inferior equipment.
- 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.
- Defective testing – certifying that something has passed a test, when in fact it has not.
- “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.
- Unbundling – Submitting multiple billing codes instead of one billing code for a drug panel test in order to increase remuneration.
- 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.
- Billing for brand — billing for brand-named drugs when generic drugs are actually provided.
- 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.
- Falsifying natural resource production records — pumping, mining or harvesting more natural resources from public lands that is actually reported to the government.
- Being over-paid by the government for sale of a good or service, and then not reporting that overpayment.
- Misrepresenting the value of imported goods or their country of origin for tariff purposes.
- False certification that a contract falls within certain guidelines (i.e. the contractor is a minority or veteran).
- Billing in order to increase revenue instead of billing to reflect actual work performed.
- Failing to report known product defects in order to be able to continue to sell or bill the government for the product.
- Billing for research that was never conducted and/or falsifying research data that was paid for by the U.S. government.
- 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.
- Billing for unlicensed or unapproved drugs.
- Forging physician signatures when such signatures are required for reimbursement from Medicare or Medicaid.
