TYPICAL CLAIMS UNDER THE FLORIDA FALSE CLAIMS ACT
- General Claims
- Claims Against Providers of Medical Services, Supplies or Equipment
- Sales of Ordinary Goods to any Agency of The State
- Claims Against Government Contractors
- Claims Against Colleges and Universities
Virtually anyone who receives money from a governmental agency or pays money to a governmental agency, can engage in conduct which would give rise to a qui tam violation. Activities which constitute a violation under the Florida False Claims Act include, but are not limited to:
(a) knowingly presenting, or causing to be presented, to a governmental agency a false or fraudulent claim for payment;
(b) knowingly using, or causing to be used, a false record or statement to get a claim paid by a governmental agency;
(c) conspiring with others to get a false or fraudulent claim paid by the State;
(d) knowingly using, or causing to be used, a false record or statement to conceal, avoid or decrease an obligation to pay money or transmit money to a governmental agency.
Claims Against Providers of Medical Services, Supplies or Equipment
A substantial portion of the monies recovered under False Claims Acts, involve cases against Doctors, Hospitals, Clinics and companies or entities which were engaged in the practice of providing medical services, medical supplies and/or medical equipment.
All too often such entities and individuals receive monies from Medicare, Medicaid, or other medical insurance which is funded in whole or in part, by the State of Florida. This gives rise to a wide variety of qui tam violations, the most typical of which are as follows:
Billing for Brand - Billing for brand name drugs when generic drugs are actually provided.
Bundling - Billing more for a panel of tests when a single test was asked for.
Concealment - Failing to disclose, or taking affirmative acts to conceal billing errors which resulted in overpayment for services or goods provided.
Double Billing - Charging more than once for the same goods or service.
Equipment Billing Fraud - Billing for the use of new equipment, or premium equipment, when either used or inferior equipment is provided.
Inflated Management Fees - Artificially inflating management fees in situations where the government pays management fees in connection with any provision of medical services, or in the conduct of government-sponsored medical research.
Kickback Fraud - Prescribing a medicine or recommending a type of treatment or diagnosis regimen in order to win kickbacks from hospitals, labs or pharmaceutical companies.
“Lick & Stick” - Prescription rebate fraud and “marketing the spread” prescription fraud both of which involve lying to the Government about the true wholesale price of prescription drugs.
Phantom Billing - Billing for tests, goods and services that were never delivered or rendered.
Phantom Labor - Charging for employees that were not actually on the job, or billing for made-up hours to maximize reimbursements.
Retention of Overpayments - Being overpaid by the Government for a service or good, and then not reporting the overpayment to the Government.
Shelling - Setting up a shell company, or manipulating the mode or receiving payments for the purpose of inflating the rate of reimbursement to be received.
Shorting - Charging for full quantities of prescriptions, when actually dispensing partial or short prescriptions.
Signature Fraud - Forging physician’s signatures when such signatures are required for reimbursement from Medicare or Medicaid.
Unapproved Billing - Filing claims for reimbursement of expenses and for services while knowing that such reimbursements and services were not covered by Medicaid or Medicare. Billing for unlicensed or unapproved drugs or devices.
Unbundling - Using multiple billing codes instead of one billing code for a drug panel test in order to increase remuneration.
Unwarranted Billings - Billing for services which were not reasonable or necessary, in frequency, duration, or at all. Billing for medically unnecessary tests. Automatically running a lab test whenever the results of some other test fall within a certain range, even though the second test was not specifically requested.
Upcoding Diagnoses - Inflating bills by using diagnosis billing codes that suggest a more expensive illness or treatment.
Upcoding Employee Work - Billing at doctor rates for work that was actually performed by a nurse or resident intern.
Upcoding Services/Goods - Billing for a more highly reimbursed service or product than the one provided.
Sales of Ordinary Goods to any Agency of The State
Virtually any individual or company which sells ordinary goods or merchandise to any governmental agency within the State of Florida may violate the False Claims Act.
Some typical claims which have been filed against commonly known retailers are as follows:
Phantom Charges - Charging a governmental agency for goods which were not actually provided, in whole, or in part.
Defective Goods - Selling defective goods to a governmental agency. Selling a governmental agency used equipment as new equipment. Presenting broken or untested equipment as operational and tested.
False Certifications - Providing false certification that a product meets specifications required by a governmental agency. Providing false certification that products being supplied are being subjected to testing procedures in accord with governmental agency requirements, when such testing had not been performed.
Retention of Overpayments - Being overpaid by a governmental agency for a service and then not reporting the overpayment to the governmental agency.
Claims Against Government Contractors
Government Contractors often engage if fraudulent conduct which can serve as a basis of claims under the False Claims Act.
Typical claims against Government Contractors include, but are not limited to, the following:
Phantom Billing - Charging a governmental agency for labor or services not provided, in whole or in part.
Overcharging - Overcharging a governmental agency for labor or services provided.
Upcoding - Charging a governmental agency at labor rates higher than permitted, or billing for a skilled or licensed tradesman, when an unskilled or unlicensed laborer was used.
Mischarging - Mischarging time, by billing the government for time or labor which was actually expended on other matters. Billing for marketing, lobbying or other non-contract related activities.
Procurement Fraud - Providing false certification that minority or female contractors are providing services, or are the true principals of the company or companies providing services, or providing other false information to secure contracts from a governmental agency.
False Testing - Submitting false service records or samples to show better than actual performance.
Retention of Overpayments - Being overpaid by a governmental agency for a service and then not reporting the overpayment to the governmental agency.
Claims Against Colleges and Universities
Data Falsification - Falsifying research data that was paid for by the State.
Fraudulent Billing - The employ of fraudulent billing practices at University clinics and programs to obtain unearned Medicaid funding.
Grant Noncompliance - When a College or University fails to comply with the restrictions which govern the permitted use, method and manner of expending monies they have received from the State.
Misappropriation - When a College or University uses funds received from the State for any purposes other than the specific purpose for which such funds had been given to them by the State.
Phantom Research - Charging the State for research that was never conducted.
Retention of Overpayments - When a College or University receives an overpayment of State funds, or realizes a surplus from State funds received, due to an expense being less than previously anticipated, and the official or local government fails to report the overpayment or excess to the State.
To read about actual cases, go to the NEWS section of this web site.
Or, to obtain more information, contact:
Andrew J. Campanelli
Campanelli & Associates, P.C.
623 Stewart Avenue
Suite 203
Garden City, NY 11530
(516) 746-1600
