What is Healthcare Fraud?

Government spending on healthcare and the cost of healthcare in general has risen dramatically in the past few decades. With costs continuously escalating, the federal government has more incentive than ever before to root out the fraud and corruption in the healthcare sector that costs taxpayers billions of dollars each year.

Types of Healthcare Fraud

A violation of the False Claims Act in the healthcare sector generally involves submitting false claims to government healthcare programs — such as Medicare, Medicaid, and TRICARE — as well as overbilling, or receiving payments under these programs while not in compliance with healthcare regulations.

Companies and health care providers that participate in federally funded healthcare programs are held to a very strict standard of compliance. Those who are not in compliance with the law and still receive payment from these programs are potentially liable under the False Claims Act— even without evidence of direct, intentional fraud in billing or reimbursement.

The most common types of healthcare fraud include:

Medicare and Medicaid Fraud

Anti-Kickback Violations

Stark Law Violations

Medical Device and Implant Fraud

Ambulance Fraud

Cost Report Fraud

Durable Medical Equipment Fraud

Upcoding and Unbundling Fraud

Home Healthcare Fraud

Rehabilitation Services Fraud

Skilled Nursing Facility Fraud

Hospital Inpatient Fraud

Hospital Outpatient Fraud

Long-term Acute Care Hospital (LTACH) Fraud

Medicare Advantage Risk Scoring Fraud

Tax Fraud

SEC Fraud

Do you know of a possible case of healthcare fraud? The attorneys at Kenney & McCafferty have the skills and experience to hold wrongdoers accountable for their fraudulent actions — and help you maximize your whistleblower rewardContact us for a free consultation today.

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