Types of Fraud
There are many types of fraud that are eligible to be prosecuted
under qui tam law. Some of the most common methods of fraud
involve defense contractors and health care professionals
providing care that is subsidized by Medicare and Medicaid.
Health Care Fraud
The following are examples of fraud in the health care industry
that is covered by the False Claims Act:
- "Phantom billing" - Billing
for tests not performed.
- Performing inappropriate or unnecessary
- Charging for equipment/supplies that were
- Billing Medicare/Medicaid for new equipment
while providing a patient with used equipment.
- Billing Medicare/Medicaid for expensive
equipment while providing a patient with less expensive
- A drug or equipment supplier completing
a Certificate of Medical Necessity (CMN) instead of the
- "Reflex testing" - Automatically
running a test whenever the results of some other test fall
within a certain range, even though the reflex test was
not requested by a physician.
- "Defective Testing" - When a test
or part of a test was not performed because of technical
trouble (ie: insufficient or destroyed sample, machine malfunction)
but is billed to the government anyway.
- "Code jamming" - Laboratories inserting
or "jamming" fake diagnosis codes to get Medicare/Medicaid
- Offering free services or supplies in exchange
for your Medicare or Medicaid number.
- "Unbundling" - Using two or more
Current Procedural Terminology ("CPT") billing
codes instead of one inclusive code for a defined panel
where rules and regulations require "bundling"
of such claims. Submitting multiple bills, in order to obtain
a higher reimbursement for tests and services that were
performed within a specified time period and which should
have been submitted as a single bill.
- "Double billing" — charging
more than once for the same service. For example, a health
care provider billing using an individual code and then
again as part of an automated or bundled set of tests.
- "Up-coding" - Inflating bills by
using diagnosis billing codes that indicate the patient
experienced medical complications and/or needed more expensive
treatments. (eg., billing for complex services when only
simple services were performed, billing for brand-name drugs
when generic drugs were provided, listing treatment as having
been for a more complicated diagnosis than was actually
- "Phantom Employees" - Expensing
employees or hours worked that do not exist.
- "Improper Cost Reports" —
Submitting false cost reports seeking higher Medicare reimbursements
than permitted by actual facts.
- Providing substandard nursing home care
and seeking Medicare reimbursement.
- Routinely waiving patient co-payments.
To protect your interests and prevent retaliation, whistleblowers
should contact Dozier Law Group to speak with an experienced
qui tam lawyer before taking any further action.
Defense Contractor Fraud
Companies that win contracts for the United States Department
of Defense are often under pressure to produce many products
in a short time period. As a result, employers may ask their
employees to falsify time records and other company documents
to show additional hours which were supposedly spent on high-profit
government projects. In other cases, defense contractors may
produce defective products or substitute parts that are either
inferior or from sources other than those agreed upon in the
If you believe that a company is guilty of defrauding the
government and there is independent evidence to support your
belief, call (404) 949-5600 to speak directly with Managing
Principal Brad Dozier, an experienced qui tam attorney, or
. We encourage you not to delay seeking legal representation,
as a financial recovery under the qui tam law could be lost
if another person brings the claim before you do.
Tam Claims | Qui-Tam
Law Defined | Types
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