Khurana
Law Firm

Medicare whistleblower lawyer

Whistleblower and qui tam attorneys battling Medicare and Medicaid scams in Castro Valley, California

Medicare and Medicaid fraud cost California taxpayers billions of dollars each year. While the majority of medical companies and drug companies are honest and work within the legal channels, some do not. When fraud occurs, everyone can lose. Medicaid and Medicare whistleblower lawyers can assist healthcare professionals to file suits on behalf of the federal or state government to help report this type of fraud.

The state and federal government place a lot of trust in pharmaceutical and medical companies. When that trust is ill-placed, the government relies on regular folks in California to come forward to report scams. People like you.

Work with

Experienced Medicaid and Medicare whistleblower lawyers; representing health care workers in Castro Valley, California

At Khurana Law Firm, P.C., as knowledgeable Medicare and Medicaid whistleblower legal representatives, we support your heroic decision to come forward to report abuse and fraud in the market. We know that stepping forward is difficult and numerous things may be at stake. When you come to us, your case is kept in the strictest confidence .

With our comprehensive experience representing whistleblowers nationwide, we thoroughly investigate your claim, diligently prepare your case, and work relentlessly with both you and the state of federal government to help bring fraudulent Medicaid or Medicare activity to justice.

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Whistleblower Laws in Castro Valley, California

Medicaid fraud cost citizens countless dollars every year in California. The California False Claims Act enables people who know of Medicaid scams the ability to submit a civil complaint on behalf of the state, county, municipality, public school, or any government agency that may have been defrauded.

 

In addition, California is one of just two states in the country with a qui tam statute that attends to fraud committed against private insurance companies. The California Insurance Frauds Prevention Act (“IFPA”) permits people to submit private qui tam suits against anybody who executes insurance scams in the State.

 

Under both laws, it is a civil offense for any individual, company, or insurance provider to submit fraudulent claims, misappropriate public property, deceptively prevent financial commitments, or returns of funds to the government. Whistleblowers who know of such activity can submit a qui tam lawsuit to recover the damage done to the government and, in addition, gather a potential financial incentive for whistleblowing.

 

If there is a financial recovery by the State or other subdivision of government under the California False Claims Act, the whistleblower might be entitled to incentives of between 15-33% of the recovery. If the lawsuit was prosecuted separately, the whistleblower’s reward potential increases to 25-50% of the funds recovered.

 

If there is a recovery by the state under the IFPA, the whistleblower may be entitled to rewards of in between 30-40% of the recovery if the government intervenes and 40-50% of the recovery if the government does not intervene.

Liability of the Defendant in Castro Valley, California

Under the California False Claims Act, the offender might be mandated to pay up to three times the amount of damage to the government along with fines of $5,500 to $11,000 per infraction.

Statute of Limitations in Castro Valley, California

In California, people filing a whistleblower lawsuit under the California False Claims Act must usually file their grievance within six years of the infraction, but, there might be extensions in some instances.

Working With an Experienced Whistleblower Lawyer

If you have learned of fraudulent Medicaid activity against the state of California or fraudulent activity against a private insurer, you need to get the legal guidance and assistance of an experienced whistleblower lawyer. At Khurana Law Firm, P.C., we have dedicated our practice to whistleblowers and combating scams. Contact us for a completely confidential, no-cost assessment to discuss your case.

What is

Medicare Advantage Fraud

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:

Upcoding

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.

Chart reviews

The MA provider reviews charts to add additional diagnosis codes.

Chart mining

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.

Adding unsupported diagnosis

Coders are directed to add codes based on other information in the chart.

Not removing old diagnosis codes

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.

Sham RADV audits

The MA provider reviews charts to add additional diagnosis codes.

Incentivizing doctors

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.

Pre-filling charts

Coders are directed to add codes based on other information in the chart.

If you suspect Medicare Advantage Fraud, you are a healthcare worker in Castro Valley, California, get in touch with us here.

Khurana Law Firm, P.C.
Medicare Fraud
Medicare Fraud is a Serious Problem

While there are no exact figures concerning Medicare fraud, we do know it is a huge problem. In the fiscal year 2020, the government recovered over $1.8 billion in civil and fraud claims relating to the healthcare industry. 

$ 0
Recovered only in 2020
YOU, the healthcare worker, provide the most vital role in combating Medicare abuse and fraud.

Watching for fraud and abuse within your organization, practice, or provider’s office helps protect everyone from this taxpayer drain and holds abusers accountable.

So what is Medicare Fraud?

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. 

Who defrauds Medicare?

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.

How do people and companies commit Medicare fraud?

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. 

What laws protect Medicare from fraudulent activity?

The False Claims Act, Anti-kickback Statute, Stark Law, and Federal Criminal Healthcare Fraud Statute hold abusers accountable for their fraudulent activity. 

What government agencies protect against Medicare fraud?

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.

How can I help?

If you see abuse and fraudulent activity you should report it. In some cases, you may even be entitled to a reward. If you are a healthcare worker in Castro Valley, California,  you can report Medicare fraud when you contact the experienced whistleblower lawyers at Khurana Law Firm, P.C. for a confidential consultation. 

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Report Medical fraud
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WORKING WITH A NATIONALLY RECOGNIZED WHISTLEBLOWER LAWYER; We are proud to represent healthcare workers in Castro Valley, California

When you become aware of potential fraud that may involve Medicaid or Medicare in Castro Valley, California, you require the guidance of an experienced whistleblower attorney, someone who can ensure that your claim is fully investigated and submitted accurately and promptly. By dealing with a knowledgeable lawyer you are increasing the chance that the federal or state government will intervene, hence increasing the possibility for a financial reward. Reporting Medicaid and Medicare fraud is an intricate matter –  don’t attempt to do this alone, we are here to help.

At Khurana Law Firm, P.C., we have years of prior experience as national qui tam legal representatives to assist in your battle against Medicaid and Medicare fraud. We will evaluate your case on a confidential, no-obligation basis. If we believe that you have a legitimate claim, we may represent you in a qui tam lawsuit to report the fraud and enable you to collect a financial benefit. Because all whistleblower work is on contingency, you pay absolutely nothing until there is a recovery. Get in touch with us today to learn how we can help.

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