5 Kinds Of Healthcare Fraud To Look Out For

Posted on February 11, 2021

Most of the agencies and businesses that provide government-funded healthcare services conduct their services properly and honestly. These industries are mostly filled with good people trying to do good work, concerned with making sure the government’s money is well-spent. 

But not everyone is so scrupulous. In 2018, the federal government recovered more than $2.3 billion in previously defrauded funds. This represents only a fraction of the more than $68 billion that the National Health Care Anti-Fraud Association estimates is defrauded annually. 

The federal government is very motivated to prevent and prosecute agencies and contractors who defraud federal money, and under certain circumstances will compensate those who alert authorities to fraudulent activity. Additionally, federal law can protect employees who come forward from retaliation by their employers, managers, or co-workers. 

If you work for a federal or federally-contracted health care agency and see or are aware of a fraud that’s being committed, Morgan & Morgan whistleblower attorneys may be able to help you file a claim and protect yourself from retaliation. 

Here are some of the most common types of health care fraud to be on the alert for:

Performing Unnecessary Services

Federal programs like Medicare and Medicaid are only designed to reimburse medical procedures and medications that are medically necessary. Health care providers who prescribe services that cannot be justified medically, and who nevertheless charge them to a program like Medicare or Medicaid, are committing fraud. 

Improperly Charging For Services

Some health care agencies and contractors have been caught charging lower prices to regular patients for the same medication or procedure while charging the government full price. 

Having Unqualified Personnel Provide Services 

The billing rules for federal programs like Medicare and Medicaid will often require specifically qualified personnel, like doctors, to provide certain examinations or procedures. To save money, some agencies and contractors will use less-qualified personnel like nurses or PAs for these services, while charging the rate of a more qualified and more expensive doctor. This is both fraudulent and a potential danger to patients. 

Taking Kickbacks 

Health care is a competitive industry, and sometimes doctors, vendors, or other contractors will offer their counterparts kickbacks in order to solicit referrals or other business. This bypassing of the open market is fraud, and often results in the government paying more for services than necessary.


Maybe the most common method of federal health care fraud, upcoding occurs when a health care provider bills the government for a more expensive service or procedure than the cheaper one that was performed or provided. This is textbook fraud and has cost the government billions. 

The Risk Can Be Worth It 

Stepping forward and blowing the whistle on your employer or co-worker can be scary. But we can protect you from retaliation, and potentially see that you’re compensated by the government. 

Remember, preventing fraud is a public service. You can help people get the services they need and protect taxpayer funds. 

So if you have seen or are aware of federal government fraud in your workplace, give us a call. We’ll review your case for free and let you know what your options are, all while maintaining the highest standards of discretion and confidentiality.