Khurana
Law Firm

Medicare whistleblower lawyer

Quit tam and whistleblower lawyers battling Medicare and Medicaid scams in San Diego, California

Medicare and Medicaid fraud cost California taxpayers billions of dollars annually. Although the majority of medical companies and drug companies are honest and work within the legal channels, some don’t. When fraud occurs, everybody can lose. Medicaid and Medicare whistleblower attorneys can help healthcare professionals to submit lawsuits on behalf of the government to report this sort of fraud.

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

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

At Khurana Law Firm, P.C., as knowledgeable Medicare and Medicaid whistleblower attorneys, we support your brave choice to come forward to report abuse and scams in the market. understand that stepping 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 substantial experience representing whistleblowers nationwide, we completely investigate your claim, diligently prepare your case, and work relentlessly with you and the state of federal government to help bring fraudulent Medicaid or Medicare activity to justice.

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Whistleblower Laws in San Diego, California

Medicaid scams cost citizens millions of dollars each year in California. The California False Claims Act permits individuals who have knowledge of Medicaid scams the ability 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 only two states in the country with a qui tam statute that attends to fraud executed against private insurance providers. 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 submit deceptive claims, abuse public property, deceptively avoid monetary commitments, or returns of funds to the government. Whistleblowers who are aware of such activity can file a qui tam lawsuit to recover the harm done to the government and, in addition, collect a potential financial incentive for whistleblowing.

 

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 incentives of in between 15-33% of the recovery. If the suit was prosecuted individually, 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 may be entitled to incentives of in between 30-40% of the recovery if the government intervenes and 40-50% of the recovery if the government does not intervene.

Liability of the Defendant in San Diego, California

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

Statute of Limitations in San Diego, California

In California, individuals submitting a whistleblower suit under the California False Claims Act should usually submit their complaint within 6 years of the offense, but, there might be extensions in some circumstances.

Working With an Experienced Whistleblower Lawyer

If you have become aware of deceptive Medicaid activity against the state of California or fraudulent activity against a private insurance business, you should get the legal advice and guidance of a knowledgeable whistleblower lawyer. At Khurana Law Firm, P.C., we have dedicated our practice to whistleblowers and combating fraud. Contact us for a confidential, no-cost assessment 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 Diego, 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 Diego, 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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Work With A NATIONALLY RECOGNIZED WHISTLEBLOWER LAWYER; We are proud to represent healthcare workers in San Diego, California

If you’ve become aware of fraudulent activity that may involve Medicaid or Medicare in San Diego, California, you need the advice of an experienced whistleblower lawyer, someone who can make sure that your claim is completely examined and filed accurately and quickly. By dealing with a skilled lawyer you are increasing the chance that the federal or state government will intervene, therefore increasing your chances for a financial reward. Reporting Medicare and Medicaid scams is a complicated matter –  don’t try to do this alone, we are here to help.

At Khurana Law Firm, P.C., we bring years of practical experience as national qui tam attorneys to assist in your fight against Medicare and Medicaid fraud. We will evaluate your case on a confidential, no-obligation basis. If we believe you have a legitimate claim, we can represent you in a qui tam claim to report the fraud and allow you to gather a financial benefit. All whistleblower cases are on contingency, you pay nothing until there is a settlement. Get in touch with us today to learn how we can help.

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