Khurana
Law Firm

Medicare whistleblower lawyer

Whistleblower and qui tam lawyers battling Medicare and Medicaid scams in Laguna Niguel, California

Medicaid and Medicare fraud cost California taxpayers billions of dollars annually. While the majority of medical service providers and drug companies are ethical and work within the system, some don’t. When scams are perpetrated, everybody loses. Medicaid and Medicare whistleblower attorneys assist healthcare professionals to file lawsuits on behalf of the government to report these kinds of scams.

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

Work with

Experienced Medicaid and Medicare whistleblower attorneys; representing healthcare workers in Laguna Niguel, California

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

With our extensive experience representing whistleblowers nationwide, we thoroughly examine your claim, diligently and carefully prepare your case, for court, and work tirelessly with both you and the state of federal government to help bring fraudulent Medicare or Medicaid activity to justice.

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Whistleblower Laws in Laguna Niguel, California

Medicaid scams cost citizens countless dollars every year in California. The California False Claims Act allows people who know of Medicaid scams the option to submit a civil complaint on behalf of the state, county, town, public school, or any government agency that has been defrauded.

 

In addition, California is one of only two states in the country with a qui tam statute that deals with fraud executed against private insurers. The California Insurance Frauds Prevention Act (“IFPA”) allows 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 private citizen, company, or insurer to submit fraudulent claims, misuse public property, deceptively prevent financial obligations, or returns of funds to the government. Whistleblowers who are aware of such activity can file a qui tam suit to recover the damage done to the government and, in addition, collect 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 may be entitled to rewards of between 15-33% of the recovery. If the suit was prosecuted independently, 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 might be entitled to incentives 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 Laguna Niguel, California

Under the California False Claims Act, the defendant might be mandated to pay up to three times the amount of damage to the government as well as fines of $5,500 to $11,000 per violation.

Statute of Limitations in Laguna Niguel, California

In California, individuals submitting a whistleblower lawsuit under the California False Claims Act need to typically submit their grievance within six years of the infraction, but, there may be extensions in some instances.

Working With an Experienced Whistleblower Lawyer

If you have become aware of deceitful Medicaid activity against the state of California or fraudulent activity against a private insurer, you need to get the legal advice 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 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 Laguna Niguel, 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 Laguna Niguel, 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 An Experienced WHISTLEBLOWER LAWYER; We are proud to represent healthcare workers in Laguna Niguel, California

When you become aware of fraud that may involve Medicaid or Medicare in Laguna Niguel, California, you need the guidance of a knowledgeable whistleblower attorney, someone who can ensure that your claim is fully examined and submitted accurately and quickly. By working with an experienced attorney you are increasing the chance that the government will step in, thus increasing the chance for a financial reward. Reporting Medicare and Medicaid fraud is a complicated matter –  do not try 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 lawyers to assist in your fight against Medicare and Medicaid fraud. After you contact us, our attorneys will evaluate your case on a confidential, no-obligation basis. If we believe you may have a legitimate claim, we may represent you in a qui tam suit to help report the scams and enable you to collect a reward. Because all whistleblower cases are on contingency, you pay absolutely nothing until there is a settlement. Get in touch with us today to learn how we can help.

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