False Claims Act Examples: Real Cases of Government Fraud
Recognizing a false claim is often the hardest part of a whistleblower case. Most relators don’t start with a legal theory — they start with a billing pattern, a contract requirement that wasn’t met, or a certification that wasn’t honest. The examples below show how false claims appear in real cases the Department of Justice has settled in recent years, organized by industry. This page covers real-world examples in Medicare and Medicaid billing, pharmaceutical kickbacks, defense contracting, pandemic relief loans, education programs, customs duties, and government grants.
Under the federal False Claims Act a “false claim” is broadly any request for government money, property, or approval based on materially false information. Nevada also has its own false-claims statute, the Submission of False Claims to State or Local Government Act (commonly called the Nevada False Claims Act), which applies to false claims involving Nevada state or local government funds.
Healthcare Fraud Examples (Medicare and Medicaid)
Examples of healthcare fraud dominate False Claims Act enforcement. In fiscal year 2025, the Department of Justice reported more than $6.8 billion in False Claims Act settlements and judgments, including more than $5.7 billion related to healthcare matters. For employees in Las Vegas, Nevada, or anywhere in the country, the most common examples of false claims in healthcare often involve Medicare, Medicaid, Medicare Advantage, TRICARE, or federally funded healthcare plans.
Upcoding and Billing for Services Not Rendered
Upcoding occurs when a provider bills the government for a more serious diagnosis, more expensive service, or higher level of care than the records support. In 2025, Seoul Medical Group and related parties agreed to pay $62.85 million to resolve allegations that they submitted unsupported diagnosis codes to Medicare Advantage plans to increase risk-adjusted payments. DOJ alleged the defendants submitted diagnoses for spinal conditions that were not supported by medical records or radiology reports. Read the full press release here.
Billing for services not rendered can take a different form. In 2023, 1st Adult & Pediatrics Healthcare Services agreed to pay $3 million to resolve allegations involving pediatric in-home health and personal-care billing. DOJ alleged that the provider billed Virginia Medicaid for in-home services for pediatric patients that were not actually provided because the patients were hospitalized at the time the in-home services were billed. Read the full press release here.
Anti-Kickback Statute Violations
Kickbacks can turn otherwise ordinary claims into false claims when payment depends on compliance with federal healthcare rules. In 2025, Pfizer agreed to pay nearly $60 million to resolve allegations that Biohaven paid improper speaker honoraria and meals to induce prescriptions of Nurtec ODT. DOJ alleged that the payments were made to healthcare professionals, including high prescribers, through speaker programs held at expensive restaurants. The relator, former Biohaven sales representative Patricia Frattasio, received approximately $8.4 million as her share of the federal recovery. Read the full press release here.
Medically Unnecessary Procedures
A medically unnecessary service can be a false claim even if a real patient was seen. In 2025, Vohra Wound Physicians and its owner agreed to pay $45 million to resolve allegations that they billed Medicare for medically unnecessary surgical procedures and used electronic records and billing software that allegedly supported higher-paying surgical billing and createcreated false medical record documentation to support the scheme. DOJ alleged that some services were routine wound care but were billed as more lucrative surgical excisional procedures. Read the full press release here.
Off-Label Pharmaceutical Marketing
Off-label promotion may support False Claims Act liability when it causes federal healthcare programs to pay for uses that are not covered or are not medically accepted. In 2025, Assertio Therapeutics agreed to pay $3.6 million to resolve allegations involving Lazanda, a fentanyl nasal spray approved only for breakthrough cancer pain in opioid-tolerant cancer patients. DOJ alleged that the company’s conduct caused Medicare and TRICARE claims for prescriptions that were not for breakthrough cancer pain. The former sales-representative relators were awarded $657,000. Read the full press release here.
Defense Contractor Fraud Examples
False Claims Act violation examples are not limited to healthcare. Defense and government-contractor cases often involve nonconforming goods, false certifications, inflated invoices, cybersecurity failures, or rigged bids.
Nonconforming Products and False Invoices
In 2025, Intelligent Waves LLC agreed to pay $1.95 million to resolve allegations involving two Air Force contracts, including work connected to the 59th Test and Evaluation Squadron at Nellis Air Force Base in Nevada. DOJ alleged that the company billed for unauthorized equipment, invoiced products and labor not delivered in the quantities billed, failed to provide credits to the Air Force for undelivered products and labor, and made false statements to obtain a contract award. The case was filed by two former employees. Read the full press release here.
Cybersecurity Certification Failures
Cybersecurity promises can be material to government payment. In 2025, Raytheon companies and Nightwing Group agreed to pay $8.4 million to resolve allegations that they failed to comply with cybersecurity requirements on Department of Defense contracts. DOJ alleged that an internal development system did not comply with required cybersecurity controls and that the defendants used the system in connection with multiple Department of Defense contracts and subcontracts. The relator, a former director of engineering, was awarded $1.512 million. Read the full press release here.
Bid Rigging and Inflated Quotes
In 2025, defense contractor Berg Companies agreed to pay $3.3 million to resolve allegations that it submitted false claims under Defense Logistics Agency prime-vendor contracts. DOJ alleged that Berg coordinated inflated quotes with other vendors so those vendors would win awards at inflated prices, causing overcharges to the military. The relators were awarded $561,000. Read the full press release here.
COVID-19 Relief Fraud Examples (PPP and EIDL)
Pandemic relief cases remain a significant category of False Claims Act enforcement. The Department of Justice reported more than 200 False Claims Act settlements and judgments involving pandemic-related fraud in fiscal year 2025.
In 2025, Patrick Walsh and affiliated companies agreed to a $20,074,458.70 consent judgment resolving allegations that they submitted false PPP and EIDL loan applications. DOJ alleged false payroll records, false employee information, dormant or inactive businesses, and loan proceeds used for personal purchases, including real estate and oil-related investments. The case began as a qui tam action by Andrew Hersh. Read the full press release here.
In 2025, YAPP USA Automotive Systems agreed to pay $14,208,496 to resolve allegations that it submitted false claims to obtain a PPP loan for which it was not eligible because it was a subsidiary of a Chinese state-owned entity. DOJ alleged the company obtained and received forgiveness of a first-draw PPP loan despite rules limiting eligibility based on size and foreign government ownership. Read the full press release here.
In 2025, Azumi entities, including Zuma Las Vegas LLC, agreed to pay $3,602,423 to resolve allegations that they obtained PPP loans for which they were not eligible. DOJ alleged that the entities exceeded the corporate-group limit applicable to second-draw PPP loans. The qui tam relator, GNGH2 Inc., was reported to receive approximately $360,000. Read the full press release here.
Other Common False Claims Act Violations
Other examples of False Claims Act cases arise in financial services, education, customs, and grant-funded research.
In 2024, Kabbage Inc. and related entities agreed to resolve allegations for up to $120 million involving PPP loan forgiveness, loan guarantees and processing fees. DOJ alleged that the lender caused false claims through improper loan calculations and deficient fraud controls. Read the full press release here.
Education and recruiting cases may involve false statement examples tied to federal student-aid money. In 2026, Study Across the Pond and its co-founder agreed to pay $1.3 million to resolve allegations that they violated the Incentive Compensation Ban by using commission-based recruiting arrangements connected to federal Direct Loan Program funds. The relator was awarded $240,500. Read the full press release here. This is also where examples of false claims in advertising can matter: advertising alone is not usually a False Claims Act case, but recruiting materials, certifications, or sham records can become relevant if they cause federal payment.
Customs fraud can also support False Claims Act liability. In 2025, Ceratizit USA agreed to pay $54.4 million to resolve allegations that it avoided customs duties by misrepresenting the country of origin and classification of tungsten carbide products from China. The relator was reported to receive approximately $9.75 million. Read the full press release here.
How to Recognize a Potential False Claims Act Violation
Most relators do not see the whole scheme at once. They see recurring facts that do not match the paperwork.
Common red flags include billing codes that appear higher than the medical record supports, claims submitted for services never provided, repeated use of cloned chart language, pressure to add diagnoses because they increase reimbursement, speaker programs or consulting fees tied to referrals, invoices for products that do not meet contract specifications, certifications submitted without verifying eligibility, grant reports that use manipulated data, or loan applications supported by payroll numbers that do not match the business’s actual records.
The key question is not whether the conduct is merely sloppy or unethical. The question is whether false information was used to obtain, increase, or keep government money. Employees, former employees, contractors, billing personnel, executives, accountants, sales representatives, and competitors may all be positioned to identify the kinds of patterns discussed on the page explaining who usually blows the whistle.
What to Do If You Suspect False Claims Act Violations
If you suspect a false claim, preserve what you lawfully have access to and avoid creating risk for yourself. Good first steps include writing a dated chronology, identifying the programs involved, preserving non-privileged records already in your possession, and keeping track of who knew what and when. The firm’s whistleblower tips guide addresses this issue in more detail. Our blog post on what evidence whistleblowers can take, also explains how to collect evidence without creating unnecessary legal exposure.
Do not confront the employer, threaten disclosure, or send allegations broadly within the company before speaking with counsel. False Claims Act cases are filed under seal at the beginning, and the complaint is not served on the defendant until the court orders service under 31 U.S.C. § 3730. Employees who report or investigate False Claims Act violations may also have statutory remedies if they are fired, demoted, harassed, or otherwise retaliated against. The firm’s page on whistleblower retaliation protections discusses those issues separately.
Frequently Asked Questions
What is the most common type of false claim?
Healthcare fraud is consistently one of the largest False Claims Act categories. In fiscal year 2025, the Department of Justice reported more than $5.7 billion in healthcare-related False Claims Act recoveries out of more than $6.8 billion total. Common healthcare examples include unsupported diagnoses, billing for services not rendered, kickbacks, medically unnecessary care, and claims caused by improper pharmaceutical marketing.
Can a False Claims Act case be filed for state-level fraud?
Yes, in some circumstances. Nevada’s Submission of False Claims to State or Local Government Act (commonly called the Nevada False Claims Act), applies to false claims involving Nevada state or local government money. A case involving both federal and Nevada funds may require analysis under both federal and state law.
How much money do whistleblowers receive in False Claims Act cases?
Under both the federal False Claims Act, 31 U.S.C. § 3730(d), and the Nevada False Claims Act, NRS 357.210, a relator’s share is generally 15% to 25% of the recovery if the government intervenes and takes over the case and 25% to 30% if the government declines and the relator successfully proceeds with the case. The DOJ also describes whistleblower awards as typically ranging from 15% to 30% of the recovery. The firm’s page on the whistleblower reward explains how these percentages work.
What is the most common amount whistleblowers receive in False Claims Act cases?
Publicly available median data are limited, but the most recent review of public settlements False Claims Act from The Anti-Fraud Coalition found the median whistleblower award between July 2024 and July 2025 was $692,999. It is important to keep in mind that many cases result in smaller awards, while some cases result in substantially larger awards. This figure also does not account for the costs, expenses, or attorneys’ fees associated with bringing and pursuing a False Claims Act case.
Do whistleblowers stay anonymous?
Under the False Claims Act, 31 U.S.C. § 3730(b), a qui tam complaint is initially filed under seal and is not served on the defendant until the court orders service. Until the seal is lifted, the person who filed the case remains a secret from the defendants. According to the Department of Justice, most cases remain under seal for approximately two years. The seal is not the same as permanent anonymity. In many cases, the relator’s identity eventually becomes known, especially if the government intervenes, the case settles, or the litigation proceeds publicly.
If you have evidence of fraud against a government program in Nevada or elsewhere in the United States, contact our whistleblower attorneys at Gallagher & Lipshutz. Call (702) 381-3770 or use the firm’s contact form for a free, confidential consultation. We represent whistleblowers throughout the Las Vegas Valley, across Nevada, and nationwide.