Khurana
Law Firm

Medicare whistleblower lawyer

Whistleblower and qui tam attorneys battling Medicare and Medicaid fraud in Thousand Oaks, California

Medicare and Medicaid fraud cost California taxpayers billions of dollars each year. While the majority of medical companies and drug companies are ethical and work within the system, some do not. When fraud happens, everyone loses. Medicaid and Medicare whistleblower lawyers assist healthcare workers to file claims on behalf of the government to help report this type of fraud.

The federal and state government place a good deal of trust in pharmaceutical and medical service providers. When that trust is ill-placed, it counts on private citizens in California to come forward and to report fraud. People like you.

Work with

Experienced Medicare and Medicaid whistleblower attorneys; representing health care workers in Thousand Oaks, California

At Khurana Law Firm, P.C., as knowledgeable Medicare and Medicaid whistleblower legal representatives, we support your brave choice to come forward to report abuse and fraud in the industry. We know that coming forward is difficult and lots of things may be at stake. When you come to us, your case is held in the strictest confidence at all times.

With our substantial experience representing whistleblowers nationwide, we thoroughly investigate your claim, diligently and carefully prepare your case, for court, and work tirelessly with both you and the federal or state government to help bring deceptive Medicare or Medicaid activity to justice.

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Whistleblower Laws in Thousand Oaks, California

Medicaid scams cost taxpayers millions of dollars each year in California. The California False Claims Act allows people who know of Medicaid scams the option to file a civil complaint on behalf of the state, county, town, public school, or any government agency that may have been defrauded.

 

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

 

Under both laws, it is a civil offense for any individual, business, or insurer to submit deceptive claims, abuse 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 suit to recover the harm done to the government and, in addition, 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 incentives of between 15-33% of the recovery. If the suit was prosecuted individually, 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 step in.

Liability of the Defendant in Thousand Oaks, California

Under the California False Claims Act, the offender may be ordered to pay up to 3 times the amount of damage to the government as well as fines of $5,500 to $11,000 per offense.

Statute of Limitations in Thousand Oaks, California

In California, individuals submitting a whistleblower suit under the California False Claims Act should generally submit their complaint within 6 years of the offense, but, there might be extensions in some circumstances.

Working With an Experienced Whistleblower Lawyer

If you have learned of deceptive Medicaid activity against the state of California or deceitful activity against a private insurance company, you ought to get the legal advice and guidance 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 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 Thousand Oaks, 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 Thousand Oaks, 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 An Experienced WHISTLEBLOWER LAWYER; We are proud to represent healthcare workers in Thousand Oaks, California

If you’ve become aware of fraudulent activity as it concerns Medicaid or Medicare in Thousand Oaks, California, you require the advice of an experienced whistleblower lawyer, someone who can make sure that your claim is completely investigated and submitted accurately and quickly. By dealing with an experienced attorney you are increasing the chance that the government will step in, thus increasing your chances for a reward. Reporting Medicaid and Medicare scams is a complex matter –  don’t try to do this alone, we are here to help.

At Khurana Law Firm, P.C., we bring years of prior experience as national qui tam legal representatives to help in your fight against Medicaid and Medicare fraud. We will examine your case on a confidential, no-obligation basis. If we believe you may have a valid claim, we may represent you in a qui tam claim to report the scams and allow you to gather a financial benefit. All whistleblower cases are on contingency, you pay nothing until there is a settlement. Contact us today to to schedule a confidential consultation.

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