The LeMay Report

Common Types of Fraud

According to the Department of Justice, over $6 billion has been recovered in False Claims lawsuits since 1986. More than half of those recoveries have involved health care fraud. Successful False Claims lawsuits have also been filed against defense contractors and other companies that work with government agencies such as NASA and Health and Human Services.

Recently, the False Claims Act is being used for fraud involving violations of labor or environmental statutes.

Samples of Fraud

The False Claims Act has been used to successfully prosecute a wide range of cases where federal dollars are involved. The scope of fraudulent activities includes, but is not limited to, the following:

"Phantom Billing" - billing for work that was not performed or services that were never rendered
Double Billing
Distribution of unapproved devices or drugs
Forgery of physicians’ signatures
Falsifying prescription records
Obtaining a contract through kickbacks
“Uncoding” – falsely claiming greater services than were performed
“Unbundling” – charging more by billing separately for procedures that should be covered by a single fee
Fraudulent cost reports
Inadequate care
Use of untrained personnel to provide services
Performing inappropriate or unnecessary work or procedures
Charging for equipment/supplies that were never ordered
Billing for brand name drugs but providing generic alternatives
"Defective Testing" – when a test or part of a test was not performed because of technical trouble but is billed anyway
Use of substandard equipment
Reporting fraudulent research results
Making false statements in applications for education and research grants
Improper use of federal funds and grant money by educational institutions
Federal funds and grants to unaccredited institutions and distance learning scams
Illegal dumping of chemicals and other violations of environmental regulations
"Yield burning"– marking up the price of Treasury securities to state and local governments, which artificially lowers their yield
Phantom employees – charging for employees who were not on the job
Creation of phony insurance companies or employee benefit plans
Offering for sale products from countries that do not have reciprocal trade agreements with the U.S.

The False Claims Act does not cover:

Tax fraud
Trust fraud
Inheritance fraud
Estate fraud

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