Khurana
Law Firm

Medicare whistleblower lawyer

Whistleblower and qui tam attorneys fighting Medicare and Medicaid fraud in Costa Mesa, California

Medicaid and Medicare fraud cost California taxpayers billions of dollars every year. Although many medical providers and drug companies are ethical and work within the legal channels, there are those who don’t. When fraud takes place, everybody can lose. Medicaid and Medicare whistleblower lawyers help healthcare workers to submit suits on behalf of the government to report this sort of fraud.

The state and federal governments put a good deal of trust in medical and pharmaceutical companies. When that trust is ill-placed, it depends on private citizens in California to come forward to report scams. People like you.

Work with

Experienced Medicaid and Medicare whistleblower lawyers; representing healthcare employees in Costa Mesa, California

At Khurana Law Firm, P.C., as experienced Medicare and Medicaid whistleblower legal representatives, we support your brave decision to come forward to report abuse and fraud in the market. understand that coming forward is not easy and lots of things may be at stake. When you come to us, your case is held in the strictest confidence .

With our substantial experience representing whistleblowers nationwide, we thoroughly examine your claim, carefully prepare your case, for court, and work tirelessly with you and the state of federal government to assist in bringing deceptive Medicaid or Medicare activity to justice.

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Whistleblower Laws in Costa Mesa, 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 has been defrauded.

 

In addition, California is among just 2 states in the country with a qui tam statute that addresses fraud committed against private insurance providers. The California Insurance Frauds Prevention Act (“IFPA”) permits individuals to file private qui tam suits against anyone who carries out insurance fraud in the State.

 

Under both laws, it is a civil offense for any individual, business, or insurer to send fraudulent claims, misuse public property, deceptively avoid monetary commitments, or returns of funds to the government. Whistleblowers who are aware of such activity can submit a qui tam suit to recover the damage done to the government and, in response, gather a potential reward for doing so.

 

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 litigated independently, the whistleblower’s reward potential increases to 25-50% of the financial recovery.

 

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

Liability of the Defendant in Costa Mesa, California

Under the California False Claims Act, the offender may be mandated to pay up to three times of damage to the government in addition to fines of $5,500 to $11,000 per offense.

Statute of Limitations in Costa Mesa, California

In California, individuals submitting a whistleblower lawsuit under the California False Claims Act need to normally file their complaint within six years of the offense, but, there may be extensions in some circumstances.

Working With an Experienced Whistleblower Attorney

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 a knowledgeable 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 consultation 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 Costa Mesa, 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 Costa Mesa, 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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Work With A NATIONALLY RECOGNIZED WHISTLEBLOWER ATTORNEY; We are proud to represent healthcare workers in Costa Mesa, California

If you’ve become aware of potential fraud that may involve Medicaid or Medicare in Costa Mesa, California, you need the advice of an experienced whistleblower lawyer, someone who can guarantee that your claim is completely investigated and filed accurately and without delay. By dealing with an experienced attorney you are increasing the chance that the federal or state government will step in, hence increasing the chance for a reward. Reporting Medicaid and Medicare fraud is an intricate matter –  do not attempt to do this alone, we are here to help.

At Khurana Law Firm, P.C., we have years of practical experience as national qui tam attorneys to assist in your battle against Medicaid and Medicare fraud. We will examine your case on a confidential, no-obligation basis. If we believe that you have a legitimate claim, we can represent you in a qui tam lawsuit to report the scams and allow you to collect a reward. Because all whistleblower work is on contingency, you pay nothing up until there is a recovery. Get in touch with us today to to schedule a confidential consultation.

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