False Claims Act Violation Examples: Common Schemes

Billing Medicare or Medicaid for services never rendered, upcoding to more expensive codes, billing for unnecessary procedures, and duplicate claims are among the most common FCA violations in healthcare.

Kickbacks and Stark Law self-referral arrangements can also render related claims false when federal program money is involved.

Drug pricing manipulation, off-label marketing paid by federal programs, and recycling or re-billing returned medications have all produced FCA recoveries.

Substituting substandard materials, falsifying test results, cross-charging costs between contracts, and misrepresenting small-business status are classic defense and infrastructure fraud patterns.

Recognizing a pattern is often the first step. Insiders who see repeated conduct — not a one-time mistake — should consider whether their facts fit the FCA framework and speak with counsel promptly.

If you recognize patterns described in this guide — especially repeated conduct backed by documents or witness knowledge — consider speaking with counsel experienced in False Claims Act litigation. Initial consultations are usually confidential; use personal phone or email, not employer systems.

For eligibility questions, reward basics, and timelines, see our pages on qui tam eligibility, whistleblower rewards, and case timelines. This article is general information only, not legal advice.