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False Claim Examples

The False Claims Act holds individuals accountable for knowingly submitting fraudulent claims to obtain payment from the Government. One example of liability is a physician billing Medicare for medical services they never actually provided. Another example is where an individual wrongfully obtains money from the Government and then creates false statements or records to keep that money. Although it is impossible to provide a complete list of all the fraud schemes covered by the False Claims Act, the following list offers some commonly seen schemes:

  • Phantom Billing: Billing for tests or services never performed or for equipment or supplies never ordered

  • Falsifying the number of employees or payroll expenses on a PPP loan to qualify for a larger loan

  • Double billing: Billing the Government twice for the same service

  • Illegal kickback payments from pharmaceutical companies to doctors for prescribing their drugs

  • Billing for non-FDA approved drugs or devices

  • Upcoding: Billing for more expensive treatment than what was really provided

  • Unbundling: Billing for services individually instead of submitting them at a bundled rate to increase payment

  • Charging for employees that were not actually in the office or for made up hours

  • Altering diagnosis coding to reflect a more severe illness than actually existed

  • Falsifying information regarding the quality or cost of products sold to the Government

  • Charging the Government for costs not related to a grant or contract

  • Submitting claims for services provided by unlicensed individuals

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