5. Whistleblower/False Claims Act – Common Types of Cases

Common Types of FCA Whistleblower Cases

Healthcare fraud cases are a huge percentage of the FCA whistleblower cases filed. For example a doctor who performs an unneeded surgery or other medical procedure on a patient is not only committing a medical malpractice, but he or she is also committing fraud by charging the patient, the government, or an insurance provider for the cost of this unneeded service. So, if these charges were made to Medicare, Medicaid, Tricare, or a children’s healthcare program, the FCA applies, and a person of conscience may decide to blow the whistle and might thereby become entitled to collect a reward for doing so. Likewise, when a doctor or a hospital misrepresents a medical procedure as being more complex and time consuming than it is, thereby charging the government a higher price for it, they are violating the FCA by fraudulent conduct commonly referred to as “upcoding.” Other types of healthcare fraud covered by the FCA include, violations of the Anti-Kickback Statute, violations of the Stark Law, and providing worthless services.

Another common type of FCA violation involves pharmaceutical manufacturers and pharmacies. This is because a large percentage of the drugs sold in the United States are paid for by the federal government through Medicare, Medicaid, and other government programs. The fact that government money is used to pay for these drugs means that misrepresentations about their pricing, quality, and necessity are covered by the FCA.

Because federal taxpayer money is used all across the United States for construction, road building, and other infrastructure, misrepresentations as to cost, quantity, quality, and necessity of these services are violations of the FCA.

Federal agricultural subsidies and programs present huge temptations for the unscrupulous to make false claims to the government to obtain undeserved payments or overpayments.

Almost every congressional district in the United States has military contractors who are selling to the government. Typical FCA violations by these contractors are overbilling, using a false cost basis, and selling the government items that don’t work, such as, bulletproof vests that are not bulletproof, etc.