Khurana
Law Firm

Medicare whistleblower lawyer

Quit tam and whistleblower attorneys battling Medicare and Medicaid fraud in San Jose, California

Medicaid and Medicare fraud cost California taxpayers billions of dollars annually. Although many medical companies and drug companies are ethical and work within the legal channels, there are those who don’t. When scams are perpetrated, everybody loses. Medicare and Medicaid whistleblower attorneys can help people who work in the healthcare system to file lawsuits on behalf of the government to report these kinds of scams.

The federal and state governments put a great deal of trust in pharmaceutical and medical companies. When that trust is ill-placed, the government counts on regular folks in California to come forward and to report scams. People like you.

Work with

Experienced Medicare and Medicaid whistleblower attorneys; representing health care employees in San Jose, California

At Khurana Law Firm, P.C., as experienced Medicare and Medicaid whistleblower lawyers, we support your brave choice to come forward to report abuse and fraud in the market. understand that stepping forward is hard 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 thoroughly investigate your claim, diligently and carefully prepare your case, for court, and work relentlessly with you and the state of federal government to assist in bringing fraudulent Medicaid or Medicare activity to justice.

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Whistleblower Laws in San Jose, California

Medicaid scams cost taxpayers millions of dollars every year in California. The California False Claims Act permits individuals who have knowledge of Medicaid scams the ability 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 only two states in the nation with a qui tam statute that attends to fraud executed against private insurers. The California Insurance Frauds Prevention Act (“IFPA”) allows people to submit private qui tam suits against anybody who executes insurance fraud 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 commitments, or returns of funds to the government. Whistleblowers who know of such activity can submit a qui tam lawsuit to recuperate the damage done to the government and, in addition, collect a potential reward for doing so.

 

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 between 15-33% of the recovery. If the lawsuit was litigated 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 between 30-40% of the recovery if the government intervenes and 40-50% of the recovery if the government does not step in.

Liability of the Defendant in San Jose, 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 along with fines of $5,500 to $11,000 per violation.

Statute of Limitations in San Jose, California

In California, individuals filing a whistleblower suit under the California False Claims Act need to generally file their complaint within 6 years of the infraction, but, there might 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 deceptive activity against a private insurance provider, you need to 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 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 Jose, 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 Jose, 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 An Experienced WHISTLEBLOWER LAWYER; We are proud to represent healthcare workers in San Jose, California

When you become aware of deceptive activity as it concerns Medicaid or Medicare in San Jose, California, you need the guidance of a knowledgeable whistleblower attorney, someone who can guarantee that your claim is fully investigated and submitted accurately and promptly. By dealing with a skilled lawyer you are increasing the chance that the federal or state government will step in, hence increasing the opportunity for a financial reward. Reporting Medicare and Medicaid fraud is a complicated matter –  don’t attempt to do this alone, we are here to help.

At Khurana Law Firm, P.C., we bring years of experience as national qui tam lawyers to help in your fight against Medicare and Medicaid fraud. After you contact us, our attorneys will examine your case on a confidential, no-obligation basis. If we believe that you have a legitimate claim, we may represent you in a qui tam lawsuit to help report the scams and enable you to collect a reward. Because all whistleblower cases are on contingency, you pay nothing until there is a recovery. Contact us today to to schedule a confidential consultation.

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