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Medicaid and Medicare fraud cost Ohio taxpayers billions of dollars each year. Although the majority of medical service providers and drug companies are honest and work within the legal channels, there are those who do not. When fraud occurs, everybody can lose. Medicare and Medicaid whistleblower lawyers assist healthcare workers to file suits on behalf of the government to help report this sort of fraud.
The federal and state government place a lot of trust in medical and pharmaceutical service providers. When that trust is ill-placed, it depends on every day people in Ohio to come forward to report scams. People like you.
At Khurana Law Firm, P.C., as knowledgeable 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 coming forward is challenging and numerous things might be at stake. When you come to us, your case is kept in the strictest confidence at all times.
With our substantial experience representing whistleblowers nationwide, we thoroughly investigate your claim, carefully prepare your case, and work tirelessly with you and the federal or state government to assist in bringing deceptive Medicare or Medicaid 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 Akron, Ohio, 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 Akron, Ohio, 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 Medicaid or Medicare in Akron, Ohio, you need the guidance of an experienced whistleblower lawyer, someone who can ensure that your claim is fully investigated and filed accurately and without delay. By working with a skilled lawyer you are increasing the chance that the federal or state government will step in, hence 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 attorneys to assist in your fight against Medicaid and Medicare scams. Our attorneys will review your case on a confidential, no-obligation basis. If we believe that you may have a valid claim, we may represent you in a qui tam suit to report the fraud and enable you to gather a reward. Because all whistleblower work is on contingency, you pay absolutely nothing until there is a recovery. Get in touch with us today to learn how we can be of help.
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