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Medicare fraud costs taxpayers billions of dollars each year. While most medical providers and drug companies are ethical and work within the system, there are those who don’t. When fraud happens, everyone loses. Medicare whistleblower lawyers help everyday citizens to file lawsuits on behalf of the government to report this kind of fraud.
The federal government places a great deal of trust in medical and pharmaceutical providers. When that trust is ill-placed, it relies on private citizens to come forward to report abuse. People like you.
At Khurana Law Firm, P.C., as experienced Medicare whistleblower lawyer, we support your heroic decision to come forward to report abuse and fraud in the industry. We know that coming forward is not easy and many things may be at stake. When you come to us, your case is held in the strictest confidence at all times.
Medicare whistleblower lawyer and with our extensive experience representing whistleblowers nationwide, we thoroughly investigate your claim, diligently prepare your case for court, and work tirelessly with you and the federal government to help bring fraudulent Medicare activity to justice.
Medicare Advantage (MA) plans are privately run healthcare options offering Medicare-eligible individuals additional services that are not included in traditional Medicare. These organizations receive payment from Medicare for each of their members that vary according to their risk adjustment. Some Medicare Advantage organizations overestimate and exaggerate a member’s risk or a patient’s diagnoses to get higher payments from Medicare. They do this by:
The MA provider increases the severity of the patient’s condition, submitting a more serious diagnosis code to get paid by Medicare at a higher rate.
The MA provider reviews charts to add additional diagnosis codes.
The MA provider mines patient’s charts to look for conditions that are not current but can put as current to increase their payments from Medicare.
Coders are directed to add codes based on other information in the chart.
The MA provider increases the severity of the patient’s condition, submitting a more serious diagnosis code to get paid by Medicare at a higher rate.
The MA provider reviews charts to add additional diagnosis codes.
The MA provider mines patient’s charts to look for conditions that are not current but can put as current to increase their payments from Medicare.
Coders are directed to add codes based on other information in the chart.
If you suspect Medicare Advantage Fraud, we are here to help. Get in touch for a no-cost, completely confidential consultation today.
Medicare pays providers for many services using Evaluation and Management codes (E/M codes). Any intentional miscoding on a claim, such as upcoding, unbundling, or otherwise overbilling, is considered Medicare fraud. This includes:
Medicare will pay claims based on E/M codes for new patients at a higher rate because the visit usually requires more time than follow-up visits. Miscoding for a new patient or misusing billing modifiers to get additional reimbursement might be fraudulent.
When a medical provider uses a code that is inaccurate for a procedure or treatment in order to increase their reimbursement by Medicare, this is considered fraudulent activity.
When a provider separately codes procedures that are performed together to maximize reimbursement, it might be considered fraud.
If you know of fraud concerning overbilling, upcoding, or double-billing, you can report it here.
While there are no exact figures concerning Medicare fraud, we do know it is a huge problem. In the fiscal year 2023, the government recovered over $2.65 billion in civil and fraud claims relating to the healthcare industry.
Watching for fraud and abuse within your organization, practice, or provider’s office helps protect everyone from this taxpayer drain and holds abusers accountable.
Fraud, as it relates to Medicare, is when individuals or entities make false statements or representations to benefit themselves at the expense of the Medicare program.
Medicare fraud can involve numerous individuals, organizations, and entities, including physicians and nurses, physician-owned groups, drug companies, home health providers, medical device providers, nursing homes, and others.
Fraud and abuse come in many different forms from coding abuses, to kickbacks, to altering records, to organized crime infiltration. Each method benefits the abuser while costing taxpayers billions.
The False Claims Act, Anti-kickback Statute, Stark Law, and Federal Criminal Healthcare Fraud Statute hold abusers accountable for their fraudulent activity.
Many government agencies strive to protect and promote the integrity of Medicare. These include the Centers for Medicare and Medicaid Services, Center for Program Integrity, US Department of Health and Human Services, and US Department of Justice, all attempting to keep Medicare fraud at bay. But they rely on people like YOU to be their eyes and ears.
If you see abuse and fraudulent activity you should report it. In some cases, you may even be entitled to a reward. To report Medicare fraud, contact the experienced whistleblower lawyers at Khurana Law Firm, P.C. for a confidential consultation.
When you become aware of Medicare fraud, you need the advice of an experienced whistleblower lawyer who can ensure that your claim is fully investigated and filed promptly and accurately. By working with an experienced attorney you are increasing the chances that the government will intervene, thus increasing your chances of a reward. Reporting Medicare fraud is a complex matter – don’t try to do this alone.
At Khurana Law Firm, P.C., we bring years of experience as national qui tam lawyers to your corner to help combat Medicare fraud. We are happy to review your case on a confidential, no-obligation basis. If we feel you have a valid claim, we represent you in a qui tam lawsuit to report the fraud and enable you to collect a reward. All whistleblower work is on contingency, so you pay nothing until there is a recovery. Contact us today to learn how we can help.
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