Buying, Selling or Stealing Patient Identities
This scheme of defrauding government health care programs involves individuals buying or selling patient identities in order to submit improper claims for reimbursement. In recent years, the government has been cracking down on this type of fraud. In this scenario, defendants buy federal health care program identification numbers from individuals in order to submit fraudulent claims to a federal health care program for health care services that were never rendered.
In some cases the beneficiary is not aware that a health care provider or entity is using the beneficiary’s health care program identification number. These cases often involve federal health care program beneficiaries that were homeless, indigent or suffering from addiction to illegal or prescription drugs. Many unscrupulous providers target these beneficiaries in soup kitchens or homeless shelters, and offer to buy the beneficiary’s Medicare number for a nominal amount – sometimes as low as $50. The provider then uses the beneficiary’s number to bill for thousands of dollars worth of services.
Grant or Research Fraud
Hospitals and research institutions receive billions of dollars annually in federal and state grants for research and other specialized projects in the health care area. Typically, these grants have strict parameters within which the money can be used. However, institutions sometimes misuse funds or mischaracterize the purposes for which they are using the funds which can lead to liability under the False Claims Act.