Merck Pays $400 Million In National Medicaid Fraud Settlement;
New Investigation Model Ends Seven-Year Qui Tam Whistleblower Case
 

Industries, Goods, and Services Eligible For Qui Tam Cases

"There is no kind of dishonesty into which otherwise good people more easily and more frequently fall than that of defrauding the Government."
--Ben Franklin

When a federal, state or local Government buys rents or licenses something, the private-sector side of the transaction may have figured out how to overcharge, double-bill, or outright lie about having provided the goods or services to the Government in the first place.

If a Government owns something and lets someone else use it in exchange for a fee or royalties, it's likely that someone has figured out how to hide the true amount owed to the Government for that use.

Federal False Claims Act ("FCA") cases track the federal Government's budget priorities, with nearly two-thirds of recoveries arising from health care cases, and half of the rest based on fraud schemes affecting military procurement.

Although health care and military spending are the most common subjects of federal qui tam suits, there are many industries and business activities where false claims abound, including:

Health Care

Billing for goods or services not rendered
Billing for goods or services not necessary
Kickbacks
Upcoding or overcharging
False reports of prices or costs
False reports of safety / efficacy of drugs or devices
Quality—so bad that it is a failure of care
Research grant diversion or misuse
Drug or product switching
False certification of compliance with laws and/or regulations

Military Spending

Passing defective parts off as safe ones
False certification of compliance with laws and/or regulations
False reports of prices or costs

False Claims of Eligibility for Loans / Benefits

Small Business Administration
Housing & Urban Development
Federal Housing Administration
General Services Administration

Education

Vocational school fraud
E-rate: phone and internet service, equipment to schools
Research grant fraud

Environmental

False certification of compliance with laws and/or regulations
False reports of prices or costs

Public Works

Construction
False certification of compliance with laws and/or regulations
False reports of prices or costs

Procurement

General Services Administration

Public Lands

Taking of oil or gas without royalty payments

Disaster Clean-Up

False claims of eligibility for loans or benefits
False certification of compliance with laws and/or regulations
False reports of prices or costs

Tax Fraud

As of January 2008, some 22 states and 2 cities have false claims, whistleblower and qui tam laws on their books. The Deficit Reduction Act of 2005 ("DRA") mandates enhanced federal/state revenue sharing for Medicaid fraud for states with qualifying false claims statutes.