Healthcare Fraud and Qui Tam


Healthcare fraud cases under the False Claims Act have grown significantly in recent years. With millions of Americans insured, in whole or in part, by health insurance paid for with federal or state government funds, healthcare spending in the United States continues to grow. In any given month, an estimated 62 million are enrolled in Medicaid, with some 75 million people enrolled at some point during a year’s time. The Kaiser Foundation reports that Medicare spent $583 billion in 2013. And, Medicaid spending totaled $456 billion in 2013. 


With nearly $3 trillion flowing through the entire health care system and insufficient accountability, there has been widespread fraud in both public programs and private insurance  Luckily, billions of dollars in health care fraud has already been exposed, largely through the efforts of qui tam whistleblowers acting under federal and state false claims acts. However, billions of dollars in additional fraud remain undetected. 


Whistleblowers are crucial. The Government alone cannot effectively compbat health care fraud. Whistleblowers under the federal and state false claims acts have detected and brought to light billions of dollars in fraud that would otherwise go undetected. 


There are many different ways in which businesses and individuals have defrauded, and continue to defraud, federal and state government health care programs. Examples of fraudulent conduct include:


  • Anti-Kickback Act Fraud

  • Stark Act Fraud

  • Medically Unnecessary Services Fraud

  • Coding Fraud

  • Durable Medical Equipent Fraud

  • Hospice Fraud

  • Home Healthcare Services Fraud

  • Pharmaceutical Fraud 


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