Medicare and Medicaid Fraud

Federal spending on health care reached $856 billion in 2012 and is expected to increase due to expansions in Medicare and Medicaid and other provisions of the federal health care reform law.  Due to the health care field’s susceptibility to fraud and abuse and the federal government’s significant financial stake, the False Claims Act has developed into an essential tool in protecting consumers, reducing inflated health care costs, and recovering government funds lost to health care fraud. Whistleblower actions and government prosecution of health care fraud under the False Claims Act accounts for nearly $6.7 billion of the $8.9 billion in total False Claims Act recoveries obtained since January 2009.  Indeed, the health care field has become the principal target for enforcement of the False Claims Act.

In recent years, the False Claims Act has enabled whistleblowers with knowledge of fraud by hospitals, medical device manufacturers, drug and pharmaceutical companies, and other health care providers to bring an action under the False Claims Act on behalf of the government to seek recovery of government funds compromised by fraud.  The False Claims Act prohibits a wide range of fraudulent activity connected with the submission of false claims to Medicare, Medicaid, and other federally-funded health care programs.  Common fraudulent schemes covered by the False Claims Act include submission of falsified cost reports, seeking Medicare or Medicaid reimbursement for services never actually provided, not medically necessary, or otherwise ineligible for reimbursement, and providing illegal financial incentives and kickbacks to other providers to induce purchase or use of particular products and services.

Cost Reports

Lack of Medical Neccessity

NIH Research Grants

Services not Rendered

Upcoding and Unbundling

Stark Law

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