Khurana
Law Firm

Medicare whistleblower lawyer

Quit tam and whistleblower attorneys battling Medicare and Medicaid fraud in Hayward, California

Medicare and Medicaid fraud cost California taxpayers billions of dollars every year. Although most medical providers and drug companies are honest and work within the legal channels, some don’t. When fraud takes place, everyone can lose. Medicare and Medicaid whistleblower attorneys assist people who work in the healthcare system to submit suits on behalf of the federal or state government to report these kinds of scams.

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

Work with

Experienced Medicare and Medicaid whistleblower attorneys; representing health care workers in Hayward, California

At Khurana Law Firm, P.C., as experienced Medicare and Medicaid whistleblower attorneys, we support your heroic decision to come forward to report abuse and fraud in the industry. We know that stepping forward is hard and numerous things might be at stake. When you come to us, your case is held in the strictest confidence at all times.

With our extensive experience representing whistleblowers nationwide, we completely investigate your claim, diligently and carefully prepare your case, and work relentlessly with both you and the state of federal government to assist in bringing deceitful Medicare or Medicaid activity to justice.

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Whistleblower Laws in Hayward, California

Medicaid fraud cost taxpayers millions of dollars each year in California. The California False Claims Act enables individuals 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 one of only 2 states in the nation with a qui tam statute that addresses fraud committed against private insurance companies. The California Insurance Frauds Prevention Act (“IFPA”) permits people to submit private qui tam suits against anyone who carries out insurance scams in the State.

 

Under both laws, it is a civil offense for any individual, company, or insurance company to submit fraudulent claims, misappropriate public property, deceptively avoid financial commitments, or returns of funds to the government. Whistleblowers who are aware of such activity can file a qui tam suit to recuperate the damage done to the government and, in addition, collect a potential reward for doing so.

 

If there is a recovery by the State or other subdivision of government under the California False Claims Act, the whistleblower may be entitled to rewards of in 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 might be entitled to rewards of between 30-40% of the recovery if the government steps in and 40-50% of the recovery if the government does not step in.

Liability of the Defendant in Hayward, California

Under the California False Claims Act, the defendant might be ordered to pay up to three times the amount of damage to the government in addition to fines of $5,500 to $11,000 per infraction.

Statute of Limitations in Hayward, California

In California, people submitting a whistleblower suit under the California False Claims Act must generally submit their grievance within 6 years of the violation, however, there might be extensions in some circumstances.

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 guidance 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 confidential, no-cost consultation in order 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 Hayward, 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 Hayward, 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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WORKING WITH A NATIONALLY RECOGNIZED WHISTLEBLOWER LAWYER; We are proud to represent healthcare workers in Hayward, California

When you become aware of fraud that may concern Medicare or Medicaid in Hayward, California, you need the advice of a skilled whistleblower attorney, someone who can guarantee that your claim is fully investigated and filed accurately and immediately. By working with a skilled attorney you are increasing the chance that the government will step in, thus increasing the opportunity for a reward. Reporting Medicare and Medicaid scams 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 fight against Medicare and Medicaid scams. We will review your case on a confidential, no-obligation basis. If we feel you may have a legitimate claim, we can represent you in a qui tam suit to help report the fraud and enable you to collect a financial benefit. Because all whistleblower work is on contingency, you pay nothing until there is a recovery. Contact us today to learn how we can help.

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