Common Types of Healthcare Fraud

Recognize the Red Flags in Healthcare Billing and Practices

Falsified or manipulated documentation

Common schemes include falsifying patient encounters or treatment, using templates without including patient specifics, and modifying the dates or symptoms to qualify for coverage or reimbursement.

Compensation tied to patient referrals

Often disguised as employee performance rewards, many schemes involve payments in exchange for the referral of patients, such as sham medical directorships or bonuses for ordering lab tests.

Self-interest loops

Providers may violate the Stark Statute in unlawful self-referral schemes by requiring subordinates to refer patients to specific laboratories or other entities in which they have a financial interest.

Payments to third parties

Payment to third-party marketers, cappers, and runners based on the value or volume of healthcare billings may violate anti-kickback statutes and encourage deceptive practices.
Doctor Shhh – GettyImages-1390023354
Know If You Have a Case

Examples of Healthcare Fraud

  • Kickbacks
  • Self-Referrals and Stark Statute violations
  • Unbundling & Upcoding
  • Unnecessary Services
Why Experience Matters

We Will Guide You Through the Whistleblowing Process

Hirst Law Group has extensive experience in helping whistleblowers with healthcare fraud cases. Our past clients include corporate executives, physicians, nurses, laboratory managers, pharmacists, medical coders, medical billers, support staff, internal sales personnel, third-party marketers, and more.

Request Consultation

How Others Have Described Our Attorneys

Clients and legal professionals weighed in:

“Their work was truly outstanding, as was the support and guidance they provided to me. Hirst Law Group was fabulous!”

Client 19

“They made me feel heard, supported, and fought for me through the end. Excellent attorneys, but most importantly great human beings.”

Client 10

“Beyond their legal skill, their personal support made an immeasurable difference. I could not have navigated this process without them.”

Client 8

“Michael Hirst and his team are modern heroes.”

Client 3

“I highly recommend Hirst Law Group to anyone needing legal assistance. Words truly cannot convey just how much I appreciate the firm.”

Client 2

“An exceptional litigator who has performed a significant public service…  The successful outcome in this case significantly advanced the Department’s efforts to combat fraudulent health care practices.”

John Ashcroft
Former Attorney General of the United States

“Tireless efforts in preparation and brilliant performance at trial.”

Dale Bosworth
Former Chief of the United States Forest Service

A “quiet but tough negotiator.”

Stephen Klaidman
New York Times journalist and author, in his book "Coronary" (Simon and Schuster, 2007)