Health Care and Government Contractor Fraud Overview

Health Care and Government contractor fraud can potentially bankrupt America's health care benefit programs and defense funds. These actions only enrich those committing the fraud. The damages can be staggering and the ongoing actions of many perpetrators suggest that these damages are simply a cost of doing business in these industries. The major types of fraud include:

• Medicare and Medicaid Fraud
• Pharmaceutical Fraud
• Defense Contractor Fraud
• Federal Government Contractor Fraud

All of these types of fraud are violations of the False Claims Act. Businesses that provide services for which reimbursement may be sought from Medicare and Medicaid funds are subject to the False Claims Act. Likewise, businesses that enter into contracts with the Government for the procurement of equipment and services are also subject to the False Claims Act. Normally, these businesses are considered to be Government Contractors.

American taxpayers and consumers of medical and pharmaceutical services should pay particular attention to the associated billing for these services. Actions such as billing for services that are not provided, incorrect data on health care provider cost reports, the provision of substandard care, and fully charging for partially filled prescriptions could be violations of the False Claims Act. Other violations can include:

  1. Kickbacks to a Medical provider in exchange for prescribing particular drugs.
  2. Medicare or Medicaid patients that are charged a higher rate for the same prescription.
  3. Substandard products and services that are intentionally provided.
  4. Prescribing unnecessary drugs and treatments.
  5. Marketing drugs for uses not approved by the FDA.

Equipment and services provided by defense contractors can include everything from computers and vehicle parts to multi-billion dollar weapons systems. Defense contractors provide these products and services via contract with the Government. These contractors can run afoul of the False Claims Act by supplying substandard parts and equipment and by participating in bidding schemes that involve price rigging, to name a few. Additionally, failing to adhere to the terms of the contract can also trigger violations. Contract terms can include billing and labor rates as well as contract performance requirements and provision of equipment and labor that meet federal statutes and regulations.