Khurana
Law Firm

Medicare whistleblower lawyer

Quit tam and whistleblower lawyers battling Medicare and Medicaid fraud in South San Francisco, California

Medicaid and Medicare fraud cost California taxpayers billions of dollars annually. While most medical companies and drug companies are honest and work within the system, some do not. When fraud takes place, everybody can lose. Medicare and Medicaid whistleblower lawyers can help healthcare workers to file lawsuits on behalf of the government to help report these kinds of scams.

The state and federal governments put a good deal of trust in pharmaceutical and medical service providers. When that trust is ill-placed, it depends on every day people in California to come forward and to report fraud. People like you.

Work with

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

At Khurana Law Firm, P.C., as knowledgeable Medicare and Medicaid whistleblower attorneys, we support your brave decision to come forward to report abuse and fraud in the industry. We know that stepping forward is not easy and many things may be at stake. When you come to us, your case is held in the strictest confidence at all times.

With our comprehensive experience representing whistleblowers nationwide, we completely investigate your claim, carefully 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 South San Francisco, California

Medicaid fraud cost taxpayers countless dollars each 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, municipality, public school, or any government agency that may have been defrauded.

 

In addition, California is one of just two states in the country with a qui tam statute that addresses fraud committed against private insurers. The California Insurance Frauds Prevention Act (“IFPA”) permits individuals to submit private qui tam suits against anyone who executes insurance scams in the State.

 

Under both laws, it is a civil offense for any private citizen, company, or insurance company to submit deceitful claims, misuse public property, deceptively prevent financial commitments, or returns of funds to the government. Whistleblowers who are aware of such activity can submit a qui tam suit to recover the harm done to the government and, in addition, collect a potential reward for whistleblowing.

 

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 lawsuit was prosecuted separately, 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 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 South San Francisco, California

Under the California False Claims Act, the defendant may be mandated to pay up to three times of damage to the government as well as fines of $5,500 to $11,000 per infraction.

Statute of Limitations in South San Francisco, California

In California, people filing a whistleblower suit under the California False Claims Act must usually file their grievance within six years of the offense, however, there might be extensions in some instances.

Working With an Experienced Whistleblower Attorney

If you have learned of fraudulent 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 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 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 South 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 South 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 LAWYER; We are proud to represent healthcare workers in South San Francisco, California

If you’ve become aware of fraudulent activity that may involve Medicaid or Medicare in South San Francisco, California, you may need the advice of an experienced whistleblower lawyer, someone who can guarantee that your claim is completely examined and submitted accurately and without delay. By dealing with an experienced lawyer you are increasing the chance that the government will step in, thus increasing the possibility for a reward. Reporting Medicare and Medicaid scams 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 prior experience as national qui tam lawyers to assist in your battle against Medicare and Medicaid fraud. Our attorneys will examine your case on a confidential, no-obligation basis. If we feel you may have a valid claim, we may represent you in a qui tam lawsuit to report the fraud and allow you to gather a reward. All whistleblower work is on contingency, you pay nothing until there is a recovery. Contact us today to learn how we can help.

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