Khurana
Law Firm

Medicare whistleblower lawyer

Whistleblower and qui tam attorneys fighting Medicare and Medicaid fraud in San Francisco, California

Medicare and Medicaid fraud cost California taxpayers billions of dollars each year. While many medical service 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 help people who work in the healthcare system to submit lawsuits on behalf of the federal or state government to help report these kinds of scams.

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

Work with

Experienced Medicare and Medicaid whistleblower lawyers; representing health care workers in San Francisco, California

At Khurana Law Firm, P.C., as knowledgeable Medicare and Medicaid whistleblower attorneys, we support your heroic decision to come forward to report abuse and fraud in the market. We know that stepping forward is challenging and lots of things might be at stake. When you come to us, your case is kept in the strictest confidence .

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

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Whistleblower Laws in San Francisco, California

Medicaid fraud cost taxpayers countless dollars every year in California. The California False Claims Act permits individuals who have knowledge of Medicaid scams the option to file 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 just 2 states in the country with a qui tam statute that addresses scams carried out against private insurers. The California Insurance Frauds Prevention Act (“IFPA”) allows people to file private qui tam suits against anybody who carries out insurance scams in the State.

 

Under both laws, it is a civil offense for any private citizen, business, or insurance company to send deceptive claims, abuse public property, deceptively avoid financial obligations, or returns of funds to the government. Whistleblowers who are aware of such activity can submit a qui tam claim to recover the harm done to the government and, in response, collect a potential reward 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 rewards of in between 15-33% of the recovery. If the lawsuit was prosecuted 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 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 Francisco, California

Under the California False Claims Act, the accused might be ordered 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 San Francisco, California

In California, people submitting a whistleblower suit under the California False Claims Act should generally file their grievance within 6 years of the infraction, but, there may be extensions in some instances.

Working With an Experienced Whistleblower Lawyer

If you have learned of deceitful Medicaid activity against the state of California or fraudulent activity against a private insurance provider, you ought to get the legal advice and guidance of a knowledgeable whistleblower attorney. At Khurana Law Firm, P.C., we have dedicated our practice to whistleblowers and combating fraud. 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 San Francisco, 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 Francisco, 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 ATTORNEY; We are proud to represent healthcare workers in San Francisco, California

If you’ve become aware of fraudulent activity that may concern Medicare or Medicaid in San Francisco, California, you require the guidance of a knowledgeable whistleblower lawyer, someone who can make sure that your claim is fully examined and filed accurately and quickly. By working with a knowledgeable attorney you are increasing the chance that the federal or state government will step in, therefore increasing the opportunity for a reward. Reporting Medicaid and Medicare fraud is an intricate matter –  do not try to do this alone, we are here to help.

At Khurana Law Firm, P.C., we bring years of experience as national qui tam legal representatives to help in your fight against Medicare and Medicaid scams. After you contact us, our attorneys will review your case on a confidential, no-obligation basis. If we believe that you have a valid claim, we can represent you in a qui tam suit to report the scams and allow you to collect a financial benefit. All whistleblower work is on contingency, you pay absolutely nothing up until there is a recovery. Contact us today to learn how we can help.

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