Health care fraud takes many forms, including Medicare fraud, Medicaid fraud, and TRICARE fraud. In recent years, Medicare and 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 fraud involves off-label marketing—the illegal promotion of drugs or devices billed to government health care programs for uses not approved by the Food and Drug Administration nor supported by medical literature.

Medicare and 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
• The sale of defective medical devices

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

Report Medicare and/or Medicaid Fraud

The first step in reporting Medicare and/or Medicaid fraud is to talk to a qualified, experienced attorney, like the False Claims Act attorneys at Hodgson Russ. We will thoroughly discuss the facts of your potential case with you, reviewing the allegations and applicable law and conducting any necessary factual investigations with your participation. If you and we decide to move forward with our representation of you and the report of Medicare and/or Medicaid fraud, we will execute an engagement letter and draft a complaint and other case initiation documents.