There are several examples of how companies and individuals defraud the government. The following are covered under the False Claims Act:
- Kickbacks: Paying doctors or public officials for patients, referrals, prescriptions or government-funded contracts or studies.
- Self-referral Violations: Doctors referring patients to medical facilities in which they have a financial interest.
- “Up-coding”: Healthcare providers billing health insurance companies for higher-paying services or equipment that the actual service or equipment provided.
- Medically Unnecessary Tests or Services: Patients being subjected to unnecessary tests or services.
- Over-Utilization of Medical Equipment or Treatments
- Use of Unqualified Personnel: Untrained or Unauthorized practice of medicine
- Failure to Provide Services: “Billing Fraud,” charging for services not performed or billing more than one for the same service
- Overpricing for drugs, devices and equipment
- Off-label Marketing of Drugs: Selling drugs for unapproved uses
- Phantom Patients: Billing the government or health insurance companies for patients that do not exist
- Phantom Supplies: Billing government or health insurance companies for supplies that were never used.
- Phantom Prescriptions: Billing for prescriptions that never get used or dispensed
- Fabricated Invoices
- Fraudulent Referrals
If a person is in the business of committing fraud, one of the most lucrative targets is the United States government. For hundreds of years, individuals and corporations have been successful in defrauding the most powerful government in the world. With hundreds of transactions and partnerships being made every day, it is difficult for the government to keep a watchful eye on every sale or purchase it directs. Benjamin Franklin knew this all too well when he said, "There is no kind of dishonesty into which otherwise good people more easily and frequently fall than that of defrauding the government." Read more »