Medicaid Fraud

Health care fraud takes many forms, and includes Medicaid fraud, Medicare fraud, and TRICARE fraud. In recent years, Medicaid fraud whistleblower cases have represented a growing source of False Claims Act recoveries.

Some of the largest health care False Claims Act recoveries have come from the pharmaceutical industry. One common example of this kind of fraud involves off-label marketing, the illegal promotion of drugs or devices that are prescribed for uses that were neither found safe and effective by the Food and Drug Administration nor are supported by the medical literature and can be billed to government health care programs.

Medicaid false claims can also arise in the pharmaceutical context from:

• The payment of kickbacks to physicians, wholesalers, and pharmacies to induce drug or device purchases
• Other anti-kickback or Stark law violations
• The inflation of drug prices to support higher provider reimbursement coupled with marketing the spread between the government reimbursement and the provider's lower cost to induce drug purchases
• The billing for defective test kits
• The knowing failure to report a company's true best price for a drug in order to reduce rebates owed to a government program

Outside of the pharmaceutical context, the fraud Medicaid whistleblowers have commenced cases about has included various government frauds, including inflating charges, providing unlicensed medical services, billing for add-on services and costlier services that those provided, and billing for services or equipment not provided at all.