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Types of Whistleblower Cases

Medicare Fraud or Fraud in Health Care Billing

Common examples of medical fraud and fraudulent health care billing include, but are not limited to:

  • Off-label marketing of pharmaceuticals.
  • Upcoding of medical charges to a higher level of service or for more services than actually performed.
  • Violations of the Stark Self-Referral Laws.
  • Billing for services not performed or medical products not provided.
  • Double-billing.
  • Claims for health care for patients in exchange for “kickbacks.”
  • “Unbundling” of services required by Medicare rules to be “bundled.”
  • Allocating costs that should be borne by private insurers to a federal health program.
  • Billing for unallowable costs, and other costs that the federal health program doesn’t cover, such as lobbying, marketing and personal expenses. This conduct often will involve false statements concerning the true nature of the expenses.
  • Billing for unsafe or defective products sold in violation of FDA rules.

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