Kickbacks occur when healthcare providers offer or receive improper payments, gifts, or other benefits in exchange for patient referrals or services covered by Medicaid. Such arrangements may violate the federal Anti-Kickback Statute and can result in liability under the False Claims Act when they cause false claims to be submitted.

Upcoding happens when a provider uses billing codes that represent more expensive services or more severe conditions than those actually provided or documented. This practice can cause Medicaid to pay more than it should.

Healthcare employees, billing specialists, and other individuals who discover these practices may have grounds to report suspected fraud. A Medicaid false claims act lawsuit may allow eligible whistleblowers to bring information to the government through a qui tam action and potentially receive a portion of recovered funds. Legal guidance can help them understand their rights and reporting options.