Khurana
Law Firm

Medicare whistleblower lawyer

Whistleblower and qui tam lawyers fighting Medicare and Medicaid fraud in San Clemente, California

Medicare and Medicaid fraud cost California taxpayers billions of dollars each year. Although most medical service providers and drug companies are honest and work within the legal channels, some don’t. When fraud occurs, everybody loses. Medicare and Medicaid whistleblower attorneys can assist healthcare workers to file lawsuits on behalf of the government to help report this sort of fraud.

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

Work with

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

At Khurana Law Firm, P.C., as skilled Medicare and Medicaid whistleblower lawyers, we support your brave choice to come forward to report abuse and fraud in the market. understand that coming forward is challenging 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 substantial experience representing whistleblowers nationwide, we completely examine your claim, carefully prepare your case, and work tirelessly with you and the federal or state government to help bring deceitful Medicare or Medicaid activity to justice.

schedule a
confidential consultation

Whistleblower Laws in San Clemente, California

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

 

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

 

Under both laws, it is a civil offense for any individual, business, or insurance provider to send fraudulent claims, abuse 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 recover the harm done to the government and, in response, collect 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 might be entitled to incentives of between 15-33% of the recovery. If the suit was litigated independently, the whistleblower’s reward potential increases to 25-50% of the 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 San Clemente, California

Under the California False Claims Act, the defendant might be ordered to pay up to 3 times the amount of the harm to the government along with fines of $5,500 to $11,000 per offense.

Statute of Limitations in San Clemente, California

In California, individuals submitting a whistleblower claim under the California False Claims Act should generally file their complaint within six years of the violation, 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 deceptive activity against a private insurance provider, you should get the legal advice and guidance of a skilled whistleblower lawyer. At Khurana Law Firm, P.C., we have dedicated our practice to whistleblowers and combating fraud. Contact us for a completely confidential, no-cost assessment 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 San Clemente, 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 San Clemente, California,  you can report Medicare fraud when you contact the experienced whistleblower lawyers at Khurana Law Firm, P.C. for a confidential consultation. 

Call now to
Report Medical fraud
We are here to help
Work With An Experienced WHISTLEBLOWER LAWYER; We are proud to represent healthcare workers in San Clemente, California

If you’ve become aware of fraud that may concern Medicare or Medicaid in San Clemente, California, you require the guidance of a skilled whistleblower attorney, someone who can ensure that your claim is totally investigated and submitted accurately and without delay. By dealing with a knowledgeable attorney you are increasing the chance that the government will step in, therefore increasing the chance for a reward. Reporting Medicare and Medicaid 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 experience as national qui tam legal representatives to assist in your fight against Medicare and Medicaid fraud. After you get in touch our lawyers will examine your case on a confidential, no-obligation basis. If we believe that you may have a valid claim, we may represent you in a qui tam lawsuit to help report the fraud and enable you to gather a financial benefit. Because all whistleblower cases are on contingency, you pay absolutely nothing up until there is a recovery. Get in touch with us today to learn how we can help.

Service areas