Hospice care centers overbilling for patients stays
and care.
Rehabilitation centers systematically inflating
rehab bills.
Durable medical equipment fraud: kickbacks schemes
in medical sales of items such as bedding and wheelchairs.
Nursing home overbilling of staff time and patient
care.
Assisted living center fraud.
Medical coding: alteration of medical codes for
different procedures and diagnosis.
Ambulance service fraud: billing for rides not
authorized by Medicare.
"Phantom Billing" -
Billing for tests not performed.
Performing inappropriate or
unnecessary procedures.
Charging for equipment/supplies
never ordered.
Billing Medicare/Medicaid for new
equipment but providing the patient used equipment.
Billing Medicare/Medicaid for
expensive equipment but providing the patient cheap equipment.
A drug or equipment supplier
completing a Certificate of Medical Necessity (CMN) instead of the physician.
"Reflex testing" -
Automatically running a test whenever the results of some other test fall
within a certain range, even though the reflex test was not requested by a
physician.
"Defective Testing" - When
a test or part of a test was not performed because of technical trouble (ie:
insufficient or destroyed sample, machine malfunction) but is billed for
anyway.
"Code Jamming" -
Laboratories inserting or "jamming" fake diagnosis codes to get
Medicare/Medicaid coverage.
Offering free services or supplies
in exchange for your Medicare or Medicaid number.
"Unbundling" - Using two
or more Current Procedural Terminology ("CPT") billing codes instead
of one inclusive code for a defined panel where rules and regulations require
"bundling" of such claims. Submitting multiple bills, in order to
obtain a higher reimbursement for tests and services that were performed within
a specified time period and which should have been submitted as a single bill.
"Double Billing" —
charging more than once for the same service, for example by billing using an
individual code and again as part of an automated or bundled set of tests.
"Up Coding" - Inflating
bills by using diagnosis billing codes that indicate the patient experienced
medical complications and/or needed more expensive treatments. (eg., billing
for complex services when only simple services were performed, billing for
brand-named drugs when generic drugs were provided, listing treatment as having
been for a more complicated diagnosis than was actually the case.)
"Phantom Employees" -
Expensing employees or hours worked that do not exist.
"Improper Cost Reports" —
Submitting false cost reports seeking higher Medicare reimbursements than
permitted by actual facts.
Providing substandard nursing home
care and seeking Medicare reimbursement.
Routinely waiving patient
co-payments.
Fraud under the False Claims Act
means that a contractor has knowingly presented a false claim for payment to
the United States. The fraud can occur wherever federal or state monies are
directly or indirectly used to purchase services or goods. 
