In general, the False Claims Act covers fraud involving any federally or state funded contract or program, with the exception of tax fraud.
While many qui tam actions in the late 1980s and early 1990s involved Department of Defense contracts, in recent years most qui tam actions have been used to fight Medicare fraud and fraud against other federally funded health care programs. A broad array of scenarios can constitute FCA violations. Some examples include the following:
A contractor falsifies test results or other information regarding the quality or cost of products it sells to the Government;
A health care provider bills Medicare for services that were not performed or were unnecessary, or;
A grant recipient charges the Government for costs not related to the grant.
Types of Fraud Prosecuted Under the FCA
It is impossible to list all of the frauds that have been prosecuted under the False Claims Act, but the following list gives some idea of the scope of the false claims on the Government that have been uncovered to date:
Billing for goods and services that were never delivered or rendered.
Billing for marketing, lobbying or other non-contract related corporate activities.
Submitting false service records or samples in order to show better-than-actual performance.
Presenting broken or untested equipment as operational and tested.
Performing inappropriate or unnecessary medical procedures in order to increase Medicare reimbursement.
Billing for work or tests not performed.
Billing for premium equipment but actually providing inferior equipment.
Automatically running a lab test whenever the results of some other test fall within a certain range, even though the second test was not specifically requested.
Defective testing - Certifying that something has passed a test, when in fact it has not.
"Lick and stick" prescription rebate fraud and "marketing the spread" prescription fraud, both of which involve lying to the government about the true wholesale price of prescription drugs.
Unbundling - Using multiple billing codes instead of one billing code for a drug panel test in order to increase remuneration.
Bundling -- Billing more for a panel of tests when a single test was asked for.
Double billing - Charging more than once for the same goods or service.
Upcoding - Inflating bills by using diagnosis billing codes that suggest a more expensive illness or treatment.
Billing for brand -- Billing for brand-named drugs when generic drugs are actually provided.
Phantom employees and doctored time slips: Charging for employees that were not actually on the job, or billing for made-up hours in order to maximize reimbursements.
Upcoding employee work: Billing at doctor rates for work that was actually conducted by a nurse or resident intern.
Yield burning -- skimming off the profits from the sale of municipal bonds.
Falsifying natural resource production records -- Pumping, mining or harvesting more natural resources from public lands that is actually reported to the government.
Being over-paid by the government for sale of a good or service, and then not reporting that overpayment.
Misrepresenting the value of imported goods or their country of origin for tariff purposes.
False certification that a contract falls within certain guidelines (i.e. the contractor is a minority or veteran).
Billing in order to increase revenue instead of billing to reflect actual work performed.
Failing to report known product defects in order to be able to continue to sell or bill the government for the product.
Billing for research that was never conducted; falsifying research data that was paid for by the U.S. government.
Winning a contract through kickbacks or bribes.
Prescribing a medicine or recommending a type of treatment or diagnosis regimen in order to win kickbacks from hospitals, labs or pharmaceutical companies.
Billing for unlicensed or unapproved drugs.
Forging physician signatures when such signatures are required for reimbursement from Medicare or Medicaid.