Medicare and Medicaid fraud cost California taxpayers billions of dollars each year. While many medical service providers and drug companies are ethical and work within the legal channels, there are those who don’t. When fraud takes place, everybody can lose. Medicare and Medicaid whistleblower lawyers can assist healthcare workers to file lawsuits on behalf of the federal or state government to report these kinds of scams.
The federal and state governments place a good deal of trust in pharmaceutical and medical service 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.
At Khurana Law Firm, P.C., as experienced Medicare and Medicaid whistleblower legal representatives, we support your heroic decision to come forward to report abuse and scams in the industry. We know that stepping forward is difficult and lots of things might be at stake. When you come to us, your case is held in the strictest confidence .
With our extensive experience representing whistleblowers nationwide, we thoroughly examine your claim, diligently and carefully prepare your case, and work relentlessly with both you and the federal or state government to help bring deceitful Medicaid or Medicare activity to justice.
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:
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.
The MA provider reviews charts to add additional diagnosis codes.
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.
Coders are directed to add codes based on other information in the chart.
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.
The MA provider reviews charts to add additional diagnosis codes.
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.
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 Sunnyvale, California, get in touch with us here.
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.
Watching for fraud and abuse within your organization, practice, or provider’s office helps protect everyone from this taxpayer drain and holds abusers accountable.
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.
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.
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.
The False Claims Act, Anti-kickback Statute, Stark Law, and Federal Criminal Healthcare Fraud Statute hold abusers accountable for their fraudulent activity.
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.
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 Sunnyvale, California, you can report Medicare fraud when you contact the experienced whistleblower lawyers at Khurana Law Firm, P.C. for a confidential consultation.
If you’ve become aware of potential fraud that may involve Medicare or Medicaid in Sunnyvale, California, you require the advice of a skilled whistleblower lawyer, someone who can make sure that your claim is completely examined and submitted accurately and promptly. By working with an experienced lawyer you are increasing the chance that the government will intervene, therefore increasing your chances for a reward. Reporting Medicaid and Medicare fraud is a complicated matter – don’t attempt 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 assist in your fight against Medicaid and Medicare fraud. After you get in touch our lawyers will evaluate your case on a confidential, no-obligation basis. If we feel you may have a valid claim, we can represent you in a qui tam claim to report the fraud and enable you to gather a reward. Because all whistleblower cases are on contingency, you pay absolutely nothing until there is a settlement. Contact us today to to schedule a confidential consultation.
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