| Fraud Feasor |
Amount
(in millions $) |
Date |
Description
of Fraud |
Medicare |
Medicaid |
| Schering-Plough |
292 |
Jul-04 |
Cheated Medicaid on "best
price" for Claritin. |
|
X |
| Pfizer |
152 |
May-04 |
Illegal off-label marketing of
Neurontin |
|
X |
| Strategic Resource Solutions (California FCA case) |
43.1 |
Jul-04 |
Defective work on energy efficiency
contract with San Francisco public schools. |
|
|
| University Washington |
35 |
Apr-04 |
Overbilling, retroactive billing,
billing work performed by interns as if it was
performed by doctors. |
X |
|
| Health America Pennsylvania |
29.01 |
Nov-03 |
Overcharge of FEHBP on health
insurance. |
|
|
| Schering-Plough (Texas FCA case) |
27 |
May-04 |
Warrick (generic drug Pfizer
subsidiary) submitted false pricing on albuterol
asthma inhalant. |
|
X |
| WorldCom |
27 |
May-04 |
Charging to the government
costs and fees for long-distance telephone services
that were not allowable under the contract. |
|
|
| Tenet Florida |
22.5 |
Mar-04 |
FCA violations arising from
Stark Law violations; improper hospital cost report
claims. |
X |
|
| Travelers and UnitedHealth |
20.6 |
Aug-04 |
Overbilling, manipulation of
records, failure to provide contracted services. |
|
|
| NEC Computers (Nippon Electric
Company) |
20.5 |
May-04 |
E-rate fraud; overcharges for
networking computers in San Francisco public schools. |
|
|
| Adventist Health System,
Sunbelt Healthcare Corporation, three affiliated
hospitals and a management company |
20.3 |
Aug-04 |
Overcharged Medicare and
fraudulently billed for ambulance transports that
were not medically necessary. |
x |
|
| Augustine Medical |
12.75 |
May-04 |
Billing for "Warm Up Wound Care
Therapy" product, which turned out to be Saran
Wrap and double-sided tape. |
X |
|
| Montefiore Hospital |
12 |
Mar-04 |
Improper retention of Medicare
overpayments. |
X |
|
| Quest Diagnostics |
11.35 |
Mar-04 |
Billing for medically unnecessary
laboratory tests. |
x |
|
| Health Line Clinical Labs |
10 |
Apr-04 |
Medicare and Medicaid fraud
for five specific medically unnecessary blood
tests. |
X |
X |
| CMC Electronics |
9.6 |
Apr-04 |
Overbilling and use of used parts in
Patriot Missile communications system. |
|
|
| Saint Francis Hospital |
9.5 |
Feb-04 |
Administrative settlement with HHS
after self-disclosure related to durable medical
equipment, hospice care, and home health care. |
|
|
| Cushman & Wakefield |
8.4 |
Sep-04 |
Underpaid postage due involving a mail
presort business they operated. |
|
|
| Tenet Healthcare Corp. |
8.25 |
Mar-04 |
Overbilled Medicare for
patients who were transferred to other hospitals. |
X |
|
| Rite Aid Corp. |
7 |
Jun-04 |
Short-filling prescriptions. |
|
X |
| Metropolitan Hospital, Grand Rapids,
Michigan |
6.25 |
Dec-03 |
Stark violations, improper records. |
X |
|
| Banner Health |
6.1 |
Jun-04 |
False billing for home health care
visits that were deemed unnecessary or unreasonable. |
X |
|
| Boeing |
6 |
Sep-04 |
Use Russian titanium in contract that
required "made in America" sources for F-15
Eagle fighter and the F/A-18 Hornet fighter. |
|
|
| LA Metro Transport. Assoc. (California FCA case) |
5.3 |
Jun-04 |
False certification for "Buy
American" goods and for minority and women-owned
business. |
|
|
| Bank of China |
5.25 |
Oct-03 |
Reverse false claims. Bank
financed scheme to falsify origin of mushrooms to
avoid anti-dumping duties. |
|
|
| Vortec |
4.6 |
Aug-04 |
Falsified hazardous waste research
grant. |
|
|
| Vantage Group |
4.5 |
Oct-03 |
Misuse of nonprofit postal rates. |
|
|
| Stephens, Robert |
4.25 |
Jun-04 |
Defrauded the government of Federal
farm payments by creating dummy corporations to
increase payment amounts. |
|
|
| Norwalk Hospital / Valley
(Coast) Plaza Doctors Hospital |
4.1 |
Feb-04 |
False claims to Medicare for expenses
not actually incurred. |
X |
|
| Howmet |
4 |
Oct-03 |
False claims for helicopter and
missile parts that did not meet contract
specifications. |
|
|
| University of California |
3.9 |
Feb-04 |
Managers of an energy research program
at Lawrence Livermore National Laboratory improperly
allocated costs to other DOE-funded program at U. of
California facility. |
|
|
| Polaroid |
3.2 |
Mar-04 |
Polaroid provided false
pricing information and certifications. |
|
|
| Science and Applied Technologies |
3.05 |
Dec-03 |
False claims regarding advanced
anti-radiation guided missile program. |
|
|
| Majumder, Parthasarathi |
3 |
Apr-04 |
Illegal reimbursement for
political contributions charged to government defense
contracts. |
|
|
| Educators Mutual Insurance |
2.86 |
Aug-04 |
Violation of Medicare Secondary Payer
law on kidney transplants and dialysis services. |
X |
|
| Wal-Mart
|
2.8 |
Feb-04 |
Short-filling prescriptions. |
|
X |
| Kerlan-Jobe Orthopedic Clinic |
2.65 |
Jan-04 |
Overpayments for doctor visits and
medical procedures. |
X & Tricare |
X |
| Johns Hopkins |
2.6 |
Feb-04 |
Non-compliance with federal research
effort reporting regulations. |
|
|
| Radiology Regional Center (Miami) |
2.53 |
Jun-04 |
Submission of false bills for services
not ordered by physician (MRIs, ultrasound,
reconstruction). |
X |
|
| Harvard & Beth Israel |
2.4 |
Jun-04 |
Misuse of research and
training grants for paying salaries and expenses. |
|
|
| Cleveland Clinic Home Care |
2.3 |
Jan-04 |
False cost report claims for
non-home-health costs associated with Meridia Health
System. |
X |
|
| University of Chicago |
2.3 |
Nov-03 |
False claims relating to patient
eligibility for liver transplant services. |
X |
|
| Downey Regional Medical Center (DRMC) |
2.22 |
Aug-04 |
Claimed and received reimbursement
from Medicare of expenses which were non-allowable
and non-reimbursable pursuant to Medicare
regulations, including certain lobbying, legal, and
marketing expenses. |
X |
|
| Photon
Research Associates |
1.9 |
Oct. 7 -04 |
Software company deliberately
overcharged U.S. defense and intelligence agencies
for labor costs on government contracts dealing with
satellite tracking and target detection.
|
|
|
| KidsPeace |
1.8 |
May-04 |
Fraud involved billing for
"teaching" kids with emotional and
behavioral problems while they commuted to school on
buses, and for trips with no education value (i.e.
they were strictly recreational). |
|
|
| Northrop |
1.8 |
Apr-04 |
Faked test results of flight data
transmitters for cruise missiles. |
|
|
| St. Louis University |
1.8 |
Oct-03 |
Services provided by interns billed as
doctors. |
X |
X |
| Shelby Memorial Hospital. |
1.75 |
Jan-04 |
Improper coding of claims to Medicare. |
X |
|
| Bondcote |
1.7 |
May-04 |
Certified they did not use toxin on
military tents, but in fact did. |
|
|
| Hale Nani Rehabilitation and Nursing
Center (Beverly) |
1.7 |
Dec-03 |
Falsification of records, irregular
patient prescription practices, and kickback schemes
for pharmaceuticals. |
|
|
| Western Maryland Health (Ascension) |
1.6 |
Nov-03 |
Upcoding; billing for unauthorized
high-risk procedures. |
X |
|
| Cathedral Health care |
1.5 |
Nov-03 |
Billing inpatient rates for outpatient
services. |
X |
|
| Ernst & Young |
1.5 |
Jul-04 |
Encouraging and abetting blood testing
fraud in nine hospitals. |
|
|
| FFIA (Farallon Fixed Income
Associates) |
1.5 |
Aug-04 |
Misuse of federal resources
on Harvard University project to assist the Russian
economy. |
|
|
| Gallichia Medical Group |
1.5 |
May-04 |
Performing medically unnecessary
services. |
|
|
| Highmark |
1.5 |
Apr-04 |
Veritus division tampered with and
altered Medicare files and claims information to
improve its performance on Medicare evaluations. |
X |
|
| Physicians Specialists in
Anesthesia |
1.4 |
Jun-04 |
Anesthesiologist utilized
provider number of orthopedic surgery practice to
illegally bill Medicare as if services were being
performed incident to surgery. |
x |
|
| Accordis (HMS Holdings) |
1.35 |
May-04 |
Firm submitted inaccurate claims for
reimbursement to Medicare and California Medicaid
while handling billing for Los Angeles County. |
|
X |
| Baptist Health System |
1.3 |
Mar-04 |
Lack of physician certification of
medical necessity for services. |
X |
|
| Charleston (WV) Area Medical Center |
1.3 |
Dec-03 |
Upcoding, services not provided. |
X |
|
| Payne & Dolan, Inc. |
1.18 |
Jun-04 |
Submitted false quality
assurance and quality control data in connection with
two federally-funded road construction projects in
Michigan. |
|
|
| National Mentor Health Care |
1.17 |
Feb-04 |
False claims to New Mexico Medicaid
for services not provided. |
|
X |
| Keystone Health Plan East |
1.08 |
Jul-04 |
Used noncompliant methodology to
develop the rates charged to the Federal Employees
Health Benefits Program (FEHBP), failing to give the
FEHBP the most favorable rates Keystone gave to a
similarly situated commercial customer. |
|
|
| Omnicare of Maine |
1.08 |
Sep-04 |
Illegal drug switching by pharmacy to
defraud Medicaid. Patients switched from tablets at
$15.10 per month to capsules at $82.77 per month. |
|
X |
| Doctor's Choice Medical Equipment of
Largo |
1 |
Sep-04 |
Double-billed and submitted invoices
for phantom medical equipment. |
|
|
| Emsco Billing Services |
1 |
Jul-04 |
Over-billing Medicare and Medicaid for
emergency room services, billing at highest possible
rate regardless of services provided. Upcoding was
only done on when government was the payer. |
X |
X |
| Intrepid of North Carolina |
0.87 |
Oct-03 |
Home health care services not provided
or documented. |
|
X |
| MountainStar Health |
0.86 |
Feb-04 |
Filing false government medical
insurance reports and paying kickbacks to doctors.
MountainStar health is a Utah hospital owned by HCA. |
|
|
| Stony Brook University Hospital (SUNY) |
0.85 |
Feb-04 |
Double billing for pharmaceuticals. |
X |
|
| General Health System, Baton Rouge |
0.75 |
Oct-03 |
Nursing home failure of care |
|
X |
| Magid Glove & Safety Manufacturing
Co. |
0.72 |
Oct-03 |
Intentionally substituted work gloves
that were lower in cost and quality than the products
that had been ordered, but charged the higher prices. |
|
|
| Market Street Mortgage Corp. |
0.7 |
Aug-04 |
Submitted false and
fraudulent claims to the Department of Housing and
Urban Development and the Department of Veterans
Affairs to seek reimbursement for losses arising from
foreclosures on government insured or guaranteed
mortgage loans written by the company. |
|
|
| Fischer & Fischer |
0.68 |
Mar-04 |
False claims about legal services
related to mortgage foreclosures. |
|
|
| Rhode Island Hospital |
0.63 |
Feb-04 |
Medicare upcoding. |
X |
|
| Community Medical Center |
0.52 |
Jun-04 |
Pneumonia upcoding. |
|
|
| EastRidge Health (WV) |
0.5 |
Apr-04 |
Overbilling for mental health
services. |
|
|
| Starett Co. (L.S. Starett Co.) |
0.5 |
Sep-04 |
"Rapid Check" coordinate
measuring machines used to measure components in
aerospace, automotive and other products were
defective. |
|
|
| Lighthouse Medical Management |
0.49 |
Jan-04 |
Unnecessary ambulance transportation
for routine dialysis services. |
X |
|
| SAIC |
0.48 |
Mar-04 |
Misrepresentation on progress of
computerization project. |
|
|
| Columbia University |
0.48 |
Oct-03 |
Billing for ineligible services &
upcoding |
X |
X |
| Cooper Union (SUNY) Health System |
0.48 |
Nov-03 |
Services not provided by faculty
members at Cooper University Hospital. |
X |
|