Khurana
Law Firm

Medicare whistleblower lawyer

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

Medicare and Medicaid fraud cost California taxpayers billions of dollars annually. Although most medical companies and drug companies are honest and work within the legal channels, there are those who don’t. When scams are perpetrated, everyone loses. Medicaid and Medicare whistleblower lawyers assist healthcare workers to submit lawsuits on behalf of the federal or state government to report this type of fraud.

The federal and state government put a good deal of trust in medical and pharmaceutical service providers. When that trust is ill-placed, the government depends on every day people in California to come forward and to report scams. People like you.

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Experienced Medicaid and Medicare whistleblower lawyers; representing health care employees in Modesto, California

At Khurana Law Firm, P.C., as experienced Medicare and Medicaid whistleblower legal representatives, we support your brave choice to come forward to report abuse and fraud in the market. We know that stepping forward is not easy and numerous things might be at stake. When you come to us, your case is kept in the strictest confidence at all times.

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

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Whistleblower Laws in Modesto, California

Medicaid scams cost taxpayers millions of dollars every year in California. The California False Claims Act allows private citizens who have knowledge of Medicaid fraud the option 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 nation with a qui tam statute that addresses fraud carried out against private insurers. The California Insurance Frauds Prevention Act (“IFPA”) allows people to submit private qui tam suits against anybody who commits insurance scams in the State.

 

Under both laws, it is a civil offense for any private citizen, company, or insurance provider to send deceptive claims, abuse public property, deceptively avoid monetary responsibilities, or returns of funds to the government. Whistleblowers who know of such activity can file a qui tam suit to recuperate the damage done to the government and, in response, gather a potential financial incentive 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 may be entitled to incentives of in between 15-33% of the recovery. If the suit was litigated individually, 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 rewards of in between 30-40% of the recovery if the government steps in and 40-50% of the recovery if the government does not intervene.

Liability of the Defendant in Modesto, California

Under the California False Claims Act, the offender might be ordered to pay up to 3 times of the harm to the government in addition to fines of $5,500 to $11,000 per infraction.

Statute of Limitations in Modesto, California

In California, individuals filing a whistleblower lawsuit under the California False Claims Act need to typically submit their complaint within 6 years of the violation, however, there might be extensions in some instances.

Working With an Experienced Whistleblower Attorney

If you have become aware of deceitful Medicaid activity against the state of California or deceptive activity against a private insurance business, you should get the legal advice and assistance of an experienced whistleblower attorney. 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 Modesto, 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 Modesto, 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 Modesto, California

If you’ve become aware of potential fraud as it concerns Medicare or Medicaid in Modesto, California, you need the advice of a skilled whistleblower attorney, someone who can guarantee that your claim is totally examined and filed accurately and without delay. By dealing with a skilled lawyer you are increasing the chance that the government will step in, therefore increasing the chance for a financial 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 experience as national qui tam legal representatives to help in your battle against Medicaid and Medicare fraud. We will examine your case on a confidential, no-obligation basis. If we feel that you may have a valid claim, we may represent you in a qui tam lawsuit to report the scams and allow you to gather a financial benefit. Because all whistleblower cases are 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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