Feb 20, 2024

Signs of Fraud in the Healthcare Industry

Fraud tiles

The False Claims Act makes it illegal to falsify records or make false claims of any kind regarding a federal healthcare program. Unfortunately, some healthcare providers and individual employees still deceive the federal government to pocket extra money, filling their claims with technical medical jargon to hide their fraud. Given the importance of a trustworthy healthcare system and the lack of policing of this type of deception, the role of the whistleblower is crucial.

Healthcare providers must file claims in order to get government funding, which include expense records to justify the amounts. They can make it seem like certain procedures or medications were necessary when in reality they were not required and, in some cases, were never even performed or provided. This dangerous form of fraud takes billions of dollars from taxpayers, and whistleblowers are the first line of defense.

If you or a loved one have had the courage to blow the whistle on fraud, fill out a free case evaluation. Morgan & Morgan’s whistleblower lawyers will fight to get you full and fair compensation for your contribution and protect you from employer retaliation.

The Fraud Triangle

Why do people commit fraud? The basic factors behind the decision to commit fraud can be explained using the “Fraud Triangle,” which consists of these three criteria:

  • Opportunity: In order for fraud to occur, someone has to be in a position to steal something or exploit someone for personal gain. Opportunities arise due to issues like lack of internal controls or oversight, agencies placing too much trust in an individual employee, or (alternatively) failing to segregate duties.
  • Motivation: A person who commits fraud has some sort of motivation to do so, and it may be external or internal. They might find themselves in a tough spot financially, or they might feel slighted by their job and see a way to “get what’s theirs.”
  • Rationalization: A person who commits fraud generally:
    • Decides that the benefits outweigh the risk of being caught and the potential damages to others
    • Justifies their actions through personal necessity, dissatisfaction with their job, or feelings of entitlement

Although it’s possible to understand why it happens, healthcare fraud is still illegal and damaging to society. Morgan & Morgan is here to fight For The People and protect the rights of those who blow the whistle.

Signs of Healthcare Fraud

Fraud can be especially dangerous in the healthcare industry, where people’s lives and well-being are at stake. 

Here are a few signs of fraud you might see in the healthcare industry:

  • Prescribing unnecessary tests or medications
  • Altering medical records
  • Overbilling or double-billing
  • Billing for services that were not provided (also known as “phantom billing”)
  • Misusing government grant money
  • Providing inadequate care or defective products
  • Misconstruing the patient’s illness or condition
  • Working under false credentials
  • Misrepresenting the safety of drugs or medical devices

How Morgan & Morgan Can Help

If you have picked up on signs of fraud in the healthcare industry and want to do something about it, Morgan & Morgan can help. Our three decades of experience and team of over 1,000 lawyers give us the skills, resources, and know-how to protect those who speak up and hold wrongdoers accountable. Our proven track record includes over $20 billion won for clients across all practice areas.

Fill out a free, no-obligation case evaluation today. The consultation costs nothing and you never pay unless we win your case — and even then, you’ll never pay out of your own pocket.