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
- “Upcoding” – 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
- IIlegal 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