Government Program Fraud

The government operates many federal programs that distribute money to companies and contractors. This money is intended to cover costs that may include research & development, education, and defense.  

These payouts amount to billions of dollars every year, and it is both difficult and expensive for the government to determine whether the funds provided were used for the intended purpose. Fraud occurs when companies or individuals submit false claims to the government in order to collect money for false purposes or for services that were never provided. 

Laws exist to fight this fraud, and one of the most important among them is the False Claims Act.

Hospital Fraud

Hospital fraud is a broad term that refers to any action a hospital may take to improperly bill the Medicare and Medicaid programs. 

This type of fraud is a serious problem. A large percentage of the billions of dollars that are distributed by public health programs every year are paid directly to hospitals for the services they provide to patients and outside treatment centers.

Fraud involving hospitals is not easy to detect. Most hospitals around the nation process thousands of transactions every day as tests are performed, drugs are provided and treatments are administered. Fraud can slip through the cracks at any large facility, even without the administrators being aware of it.

The important work that hospitals do further complicates the detection of fraud. When auditors interfere with the daily operations of hospitals, it can endanger patients. In order to avoid threats to the patients, regulators rely heavily on whistleblowers within the hospital to provide evidence that proves fraud. 

Whistleblowers are highly incentivized to reveal fraud because, under the False Claims Act, they are entitled to receive a portion of all funds that are recovered.