Examples of Medicare fraud
The patterns the DOJ prosecutes most often.
2 min readUpdated 2026
Medicare 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.
The most common patterns
- Billing for services that were never performed
- Upcoding — billing for a more expensive procedure than what was actually done
- Kickbacks — payments or gifts to doctors in exchange for prescriptions, referrals, or device usage
- Medically unnecessary procedures — surgeries, tests, or treatments billed without clinical justification
- Telehealth fraud — billing for virtual visits that never happened or lasted seconds
- Billing for services under a higher-paid provider's credentials when a lower-paid staffer did the work
- Waiving patient copays as an inducement (a form of kickback)
- Hospice or home health fraud — enrolling patients who don't meet medical eligibility
Ready to find out where you stand?
Your submission stays confidential.
Frequently asked questions
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.
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.