TYPICAL CLAIMS UNDER THE NEW YORK FALSE CLAIMS ACT
- General Claims
- Sales of Ordinary Goods to any Agency of The City of New York
- Claims Against City Contractors
- Claims Against Providers of Medical Services, Supplies or Equipment
Virtually anyone who receives money from the City of New York, or pays money to the City, can engage in conduct which would give rise to a qui tam violation. Activities which constitute a violation under the False Claims Act are:
(a) knowingly presenting, or causing to be presented, to the City a false or fraudulent claim for payment;
(b) knowingly using, or causing to be used, a false record or statement to get a claim paid by the City;
(c) conspiring with others to get a false or fraudulent claim paid by the City;
(d) knowingly using, or causing to be used, a false record or statement to conceal, avoid or decrease an obligation to pay money or transmit money to the City.
Sales of Ordinary Goods to any Agency of The City of New York
Virtually any individual or company which sells ordinary goods or merchandise to any branch or office of the City, may violate the False Claims Act.
Some typical claims which have been filed against commonly known retailers are as follows:
Phantom Charges - Charging the City for goods which were not actually provided, in whole, or in part.
Defective Goods - Selling defective goods to the City. Selling the City used equipment as new equipment. Presenting broken or untested equipment as operational and tested.
False Certifications - Providing false certification that a product meets specifications required by City. Providing false certification that products being supplied are being subjected to testing procedures in accord with City requirements, when such testing had not been performed.
Retention of Overpayments - Being overpaid by the City for a service and then not reporting the overpayment to the City.
Claims Against City Contractors
City Contractors often engage in fraudulent conduct which can serve as a basis of claims under the False Claims Act. Typical claims against government contractors include, but are not limited to, the following:
Phantom Billing - Charging the City for labor or services not provided, in whole or in part.
Overcharging - Overcharging the City for labor or services provided.
Upcoding - Charging the City at labor rates higher than permitted, or billing for a skilled or licensed tradesman, when an unskilled or unlicensed laborer was used.
Mischarging - Mischarging time, by billing the City for time or labor which was actually expended on other matters. Billing for marketing, lobbying or other non-contract related activities.
Procurement Fraud - Providing false certification that minority or female contractors are providing services, or are the true principals of the company or companies providing services, or providing other false information to secure contracts from the State.
False Testing - Submitting false service records or samples to show better than actual performance.
Retention of Overpayments - Being overpaid by the City for a service and then not reporting the overpayment to the City.
Claims Against Providers of Medical Services, Supplies or Equipment
A substantial portion of the monies recovered under False Claims Acts, involve cases against Doctors, Hospitals, Clinics and companies or entities which were engaged in the practice of providing medical services, medical supplies and/or medical equipment.
All too often such entities and individuals receive monies which are funded in whole or in part, by the City.
This gives rise to a wide variety of qui tam violations, the most typical of which are as follows:
Billing for Brand - Billing for brand name drugs when generic drugs are actually provided.
Bundling - Billing more for a panel of tests when a single test was asked for.
Concealment - Failing to disclose, or taking affirmative acts to conceal billing errors which resulted in overpayment for services or goods provided.
Double Billing - Charging more than once for the same goods or service.
Equipment Billing Fraud - Billing for the use of new equipment, or premium equipment, when either used or inferior equipment is provided.
Inflated Management Fees - Artificially inflating management fees in situations where the government pays management fees in connection with any provision of medical services, or in the conduct of government-sponsored medical research.
Kickback Fraud - Prescribing a medicine or recommending a type of treatment or diagnosis regimen in order to win kickbacks from hospitals, labs or pharmaceutical companies.
“Lick & Stick” - Prescription rebate fraud and “marketing the spread” prescription fraud both of which involve lying to the government about the true wholesale price of prescription drugs.
Phantom Billing - Billing for tests, goods and services that were never delivered or rendered.
Phantom Labor - Charging for employees that were not actually on the job, or billing for made-up hours to maximize reimbursements.
Retention of Overpayments - Being overpaid by the government for a service or good, and then not reporting the overpayment to the government.
Shelling - Setting up a shell company, or manipulating the mode or receiving payments for the purpose of inflating the rate of reimbursement to be received.
Shorting - Charging for full quantities of prescriptions, when actually dispensing partial or short prescriptions.
Signature Fraud - Forging physician’s signatures when such signatures are required for reimbursement from Medicare or Medicaid.
Unapproved Billing - Filing claims for reimbursement of expenses and for services while knowing that such reimbursements and services were not covered by Medicaid or Medicare. Billing for unlicensed or unapproved drugs or devices.
Unbundling - Using multiple billing codes instead of one billing code for a drug panel test in order to increase remuneration.
Unwarranted Billings - Billing for services which were not reasonable or necessary, in frequency, duration, or at all. Billing for medically unnecessary tests. Automatically running a lab test whenever the results of some other test fall within a certain range, even though the second test was not specifically requested.
Upcoding Diagnoses - Inflating bills by using diagnosis billing codes that suggest a more expensive illness or treatment.
Upcoding Employee Work - Billing at doctor rates for work that was actually performed by a nurse or resident intern.
Upcoding Services/Goods - Billing for a more highly reimbursed service or product than the one provided.
To read about actual cases, go to the NEWS section of this web site.
Or, to obtain more information, contact:
Andrew J. Campanelli
Campanelli & Associates, P.C.
623 Stewart Avenue
Suite 203
Garden City, NY 11530
(516) 746-1600
