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.
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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.

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How Others Have Described Our Attorneys

Clients and legal professionals weighed in:

“When you’re considering a qui tam action, you’re stepping into unfamiliar and deeply intimidating territory, where trust and competence matter more than anything else. For me, it was an unnerving decision with very real personal and professional consequences. From the very beginning, working with Hirst Law Group gave me a sense of confidence and steadiness that I honestly didn’t expect to feel so quickly.

Client 9 (kickback fraud case)

“I am profoundly grateful for the representation I received from Michael Hirst of Hirst Law Group … Over the course of an extended and complex qui tam matter, they provided exceptional legal expertise, steady guidance, and unwavering support. Their command of the law, strategic insight, and commitment to their client never wavered. Beyond their legal skill, their personal support made an immeasurable difference. I could not have navigated this process without them.”

Client 8 (kickback fraud case)

“I’ve been very happy to have two highly skilled and informed professionals who exemplify this highest regard for their clients. Equally important to me is prompt response to calls and messages. There has never been a time when my queries were not answered promptly with resolution. Their dogged persistence to advocate for my best interests has been refreshing and very greatly appreciated. The Hirst Law Group operates at a very high level of the legal profession.”

Client 5 (kickback fraud case)

“I am so glad I had Hirst Law Group on my side. Working with them was such a positive experience. They are professional, knowledgeable, and dedicated. They took the time to explain everything to me and always kept me informed as we went through the very complicated and lengthy legal process.  I was very satisfied with the outcome of my case. I will miss working with Michael and Hirst Law Group now that our case is settled!  I highly recommend Hirst Law Group to anyone needing legal assistance. Words truly cannot convey just how much I appreciate the firm.”

Client 2 (healthcare fraud case)

“Hirst Law Group has been instrumental in helping me move forward with filing a qui tam lawsuit against a corrupt medical clinic. Throughout the process, they have been consistently professional, honest, and thorough. Thanks to their detailed and well-prepared court filings, the U.S. Department of Justice joined the case as a plaintiff. I am grateful for the diligence and integrity the Hirst Law Group has shown at every stage.”

Client 1 (healthcare fraud case)