What are common examples of Qui Tam Cases?
Healthcare: Fraudulent violations made by health care providers including pharmaceutical companies, hospitals, health maintenance organizations, medical marketing firms, nursing homes, long-term care facilities, pharmacies, group purchasing organizations, physician practice management groups, among others. Some common schemes include, but are not limited to: DRG fraud, upcoding, unbundling, DME overbilling, hospice fraud, home health care fraud, and ambulance service fraud. Unbundling: HCPCS codes, Healthcare Common Procedure Coding System numbers, are the codes used by Medicare for medical billing. Some healthcare providers defraud Medicare and Medicaid programs through “unbundling” or “exploding” of HCPCS codes. “Unbundling” or “exploding” refers to a billing procedure where a medical test or component of the “bundled” test is billed separately to Medicare or Medicaid in order to obtain a higher payment from government than the amount permitted. Anti-Kickback: Anti-kickback includes
