The most common types of Qui Tam or fraud cases involve efforts to defraud the Medicare and Medicaid system and benefit from Medicare and Medicaid money. This is known as Medicare and Medicaid Fraud and can manifest itself in a variety of ways including:
- Billing for services not provided – A provider bills Medicaid/Medicare for a service that was not performed.
- Double billing - A provider bills both Medicaid/Medicare and a private insurance company for treatment
- Billing for phantom visits - A provider bills Medicaid/Medicare for falsified patient visits
- Billing for more hours- Inflating the amount of time a provider spends with patients
- Falsifying credentials - Misrepresenting the qualifications of a provider to defraud Medicaid/Medicare.
- Substitution of generic drugs - A pharmacy bills Medicaid/Medicare for the cost of a brand-name prescription when a generic substitute was supplied.
- Billing for unnecessary services or services that were not performed - A provider falsifies medical symptoms in order to obtain payments for unnecessary tests or procedures. Or, a provider bills for a complex, expensive procedure, when a simple, less-expensive procedure was or should have been performed.
The False Claims Act protects your rights as a private citizen (the whistleblower) who knows of fraud committed against the government. This Act provides huge financial incentives to citizen whistleblowers to retain attorneys and come forward, prosecute these lawsuits, and fight government fraud.
Have questions about fraud cases? Contact us!