False Claims Act Violation Examples: Report Fraud Now
There are many types of False Claims Act violations across many different sectors, including healthcare and defense. This guide aims to help readers understand exactly what these violations are, and what they can do to report their concerns as a whistleblower.
Updated
May 9, 2025
The False Claims Act (FCA) is one of the most important tools for identifying fraud and uprooting it, ensuring taxpayer dollars are spent wisely, ultimately preserving important government programs.
The FCA allows ordinary citizens to bring lawsuits on behalf of the US government, also known as a qui tam action. The whistleblower, also known as a qui tam relator, receives a portion of the recovery, which can range between 15% and 30% among other factors.
In 2024, whistleblowers filed a record number of 979 qui tam suits, and reported settlements and judgments exceeding $2.9 billion in these and earlier-filed suits. The Department of Justice (DOJ) press release can be found here.
The types of fraud and violations relators are blowing the whistle on vary, but range from healthcare fraud, defense contract fraud, and other forms of procurement fraud. However, in 2024, over 57% cases were related to healthcare.
Below is an overview of the types of False Claims Act violations the government is most concerned with, in which whistleblowers can potentially receive an award if their information leads to a successful enforcement action and they meet other qualifications.
FCA Violations in Healthcare
- Inflating Costs Through Unnecessary Services: Billing federal healthcare programs (like Medicare and Medicaid) for medical services, therapies, or hospital stays that were not actually needed by the patient. For example, a skilled nursing facility allegedly billed for unreasonable or unnecessary therapy services, potentially driven by quotas for patient length of stay.
- Providing Substandard or Harmful Care: Billing for care that did not meet required standards, potentially endangering patients. For instance, allegations included facilities failing to provide adequate staffing and treatment, leading to patient harm.
- Contributing to the Opioid Crisis Through Improper Practices: Actions by healthcare providers, pharmaceutical companies, and pharmacies that facilitated the misuse and abuse of opioid medications. This could involve aggressively marketing opioids to high-volume prescribers or knowingly dispensing unlawful prescriptions.
- Illicit Financial Inducements for Referrals (Kickbacks): Offering or receiving improper payments or benefits to encourage the referral of patients for services paid by federal healthcare programs. Examples include offering lucrative medical directorships or commissions tied to the volume of referrals.
- Improper Financial Relationships Leading to Referrals (Stark Law Violations): Submitting claims for services referred by a physician who has a prohibited financial relationship with the entity providing the service. This can involve compensation to physician groups that is significantly above fair market value or bonuses tied to referral numbers.
- Fraudulent Practices in Medicare Advantage Programs: Improper actions within privately-operated Medicare plans, such as offering kickbacks for enrolling beneficiaries or submitting false claims.
- Inaccurate Reporting and Billing Practices: Failing to accurately report information that affects payments from federal healthcare programs. This includes misreporting drug rebates or billing for prescriptions that were never picked up by patients.
- Seeking Excessive Reimbursement: Improperly claiming inflated payments from federal healthcare programs, such as excessive “outlier” payments for high-cost cases.
- Billing for Ineligible Services: Claiming payment for services provided to individuals who did not meet the eligibility criteria for the program, such as hospice care for patients who were not terminally ill.
- Fraudulently Inflating Drug Prices for Reimbursement: Knowingly submitting false pricing information that leads to inflated reimbursement rates from federal programs.
FCA Violations in Military Procurement
- Overcharging the Government: Billing the military for goods or services at inflated prices through improper subcontracting or other means.
- Supplying Non-Compliant Goods: Providing materials or equipment that do not meet required military specifications or testing standards.
- Falsifying Testing or Quality Assurance Data: Manipulating test results or providing false information about the quality or performance of goods provided to the military.
FCA Violations Related to Pandemic Relief Funds
- Obtaining Ineligible Loans or Loan Forgiveness: Providing false information or certifications to receive Paycheck Protection Program (PPP) loans or loan forgiveness funds for which the entity was not eligible.
- Fraudulent Billing for COVID-19 Related Services: Submitting false or inflated claims for COVID-19 testing or treatment services.
- Improperly Claiming Funds for Uninsured Patients: Failing to adequately verify insurance status when seeking reimbursement for COVID-19 testing for uninsured individuals.
FCA Violations Related to Cybersecurity
- Failure to Meet Cybersecurity Requirements: Knowingly failing to implement required cybersecurity measures in government contracts or grants, potentially leading to data breaches.
- False Cybersecurity Assessments: Providing inaccurate information about an entity’s compliance with cybersecurity regulations.
Other FCA Violations
- Misrepresenting Commercial Sales Practices in Government Contracts: Providing false information about pricing or sales practices to secure or maintain government contracts at inflated prices.
- Violating Accessibility Requirements in Federally Funded Programs: Failing to comply with accessibility standards in programs receiving federal grants, such as housing programs.
- Underpaying Royalties on Federal Lands: Improperly calculating or reporting production volumes or prices for resources extracted from federal lands, leading to underpayment of royalties.
- Failure to Remit Government Fees: Not forwarding fees collected on behalf of the government.
- Billing for Time Not Worked on Government Projects: Submitting claims for labor costs for work that was not actually performed.
- Submitting Fraudulent Disaster Assistance Claims: Providing false information to obtain funds for disaster relief efforts.
Get Legal Assistance
If you know of FCA violations the FCA, get in touch with our qui tam attorneys today for a free and confidential case evaluation. Our team has won numerous landmark victories under the False Claims Act and here to help you better understand your rights and legal options. In many cases, we don’t get paid unless we get a recovery for you.
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During the Dodd-Frank rulemaking process, Kohn, Kohn and Colapinto’s partners worked closely with the SEC to create an effective whistleblower program.
During the Dodd-Frank rulemaking process, Kohn, Kohn and Colapinto’s partners worked closely with the SEC to create an effective whistleblower program.
Ready to blow the whistle? Our experienced team is here to protect your rights and guide you through the process. Contact us today for a confidential consultation.
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