Examples of Medicare Fraud
The most common Medicare and Medicaid fraud patterns the government prosecutes, with real-world examples.
All resourcesExamples of Medicare FraudThe patterns the DOJ prosecutes most often.
Submit Your Case SecurelyMedicare and Medicaid fraud is one of the largest sources of False Claims Act recoveries. If you've seen any of these patterns, you may have a case.
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Submit Your Case SecurelyThe most common patternsBilling for services that were never performedUpcoding — billing for a more expensive procedure than what was actually doneKickbacks — payments or gifts to doctors in exchange for prescriptions, referrals, or device usageMedically unnecessary procedures — surgeries, tests, or treatments billed without clinical justificationTelehealth fraud — billing for virtual visits that never happened or lasted secondsBilling for services under a higher-paid provider's credentials when a lower-paid staffer did the workWaiving patient copays as an inducement (a form of kickback)Hospice or home health fraud — enrolling patients who don't meet medical eligibilityKeep readingDo you have a case?Check whether what you've seen qualifies.What qualifies as fraud at workThe legal definition of fraud vs. unethical behavior.Frequently asked questionsIs upcoding really fraud?Yes — when it's intentional. Billing for a higher level of service than what was delivered is a textbook FCA violation, and upcoding schemes have produced some of the largest healthcare fraud settlements on record.Is telehealth fraud growing?Significantly. Since 2020, telehealth fraud has become one of the fastest-growing categories of healthcare FCA cases — including phantom visits, fake prescriptions, and fraudulent DME orders tied to brief or nonexistent consults.Have information about fraud?Take the quiz or submit your case securely — whichever feels right.