Khurana
Law Firm

Medicare whistleblower lawyer

Whistleblower and qui tam attorneys fighting Medicare and Medicaid fraud in Santa Cruz, California

Medicaid and Medicare fraud cost California taxpayers billions of dollars each year. Although many medical service providers and drug companies are ethical and work within the legal channels, some do not. When fraud happens, everyone can lose. Medicaid and Medicare whistleblower attorneys help people who work in the healthcare system to submit suits on behalf of the federal or state government to report this sort of fraud.

The federal and state government place a good deal of trust in medical and pharmaceutical providers. When that trust is ill-placed, it counts on every day people 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 employees in Santa Cruz, California

At Khurana Law Firm, P.C., as knowledgeable Medicare and Medicaid whistleblower legal representatives, we support your heroic choice to come forward to report abuse and scams in the market. We know that stepping forward is hard and many 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 thoroughly investigate your claim, diligently and carefully prepare your case, for court, and work tirelessly with you and the state of federal government to assist in bringing deceptive Medicaid or Medicare activity to justice.

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Whistleblower Laws in Santa Cruz, California

Medicaid fraud cost taxpayers millions of dollars every year in California. The California False Claims Act enables individuals who know 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 one of only 2 states in the nation with a qui tam statute that attends to fraud committed against private insurance companies. The California Insurance Frauds Prevention Act (“IFPA”) allows individuals to file 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, misuse public property, deceptively avoid financial commitments, or returns of funds to the government. Whistleblowers who are aware of such activity can submit a qui tam claim to recuperate the damage 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 may be entitled to rewards of in between 15-33% of the recovery. If the suit was prosecuted separately, 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 might 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 step in.

Liability of the Defendant in Santa Cruz, California

Under the California False Claims Act, the defendant may 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 Santa Cruz, California

In California, individuals filing a whistleblower suit under the California False Claims Act should normally submit their problem within six years of the offense, but, there might be extensions in some instances.

Working With an Experienced Whistleblower Attorney

If you have learned of deceitful Medicaid activity against the state of California or fraudulent activity against a private insurance provider, you need to get the legal guidance and guidance of an experienced whistleblower attorney. At Khurana Law Firm, P.C., we have dedicated our practice to whistleblowers and combating fraud. Contact us for a 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 Santa Cruz, 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 Santa Cruz, 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 Santa Cruz, California

When you become aware of fraud as it concerns Medicare or Medicaid in Santa Cruz, California, you require the advice of a knowledgeable whistleblower attorney, someone who can ensure that your claim is totally examined and submitted accurately and promptly. By working with a skilled lawyer you are increasing the chance that the government will intervene, thus increasing the chance for a reward. Reporting Medicaid and Medicare scams is a complicated matter –  do not try to do this alone, we are here to help.

At Khurana Law Firm, P.C., we have years of practical experience as national qui tam lawyers to help in your battle against Medicare and Medicaid fraud. After you get in touch our lawyers will review your case on a confidential, no-obligation basis. If we feel you have a legitimate claim, we may represent you in a qui tam lawsuit to report the fraud and allow you to gather a reward. Because all whistleblower work is on contingency, you pay absolutely nothing until there is a recovery. Contact us today to learn how we can help.

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