Khurana
Law Firm

Medicare whistleblower lawyer

Whistleblower and qui tam lawyers battling Medicare and Medicaid fraud in Montana

Medicaid and Medicare fraud cost Montana taxpayers billions of dollars annually. While many medical service providers and drug companies are ethical and work within the legal channels, there are those who don’t. When scams are perpetrated, everyone loses. Medicare and Medicaid whistleblower lawyers help healthcare professionals to submit claims on behalf of the federal or state government to help report this type of fraud.

The federal and state governments place a a lot of trust in medical and pharmaceutical providers. When that trust is ill-placed, it relies on every day people in Montana to come forward and to report fraud. People like you.

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Experienced Medicaid and Medicare whistleblower attorneys; representing health care workers in Montana

At Khurana Law Firm, P.C., as experienced Medicare and Medicaid whistleblower lawyers, we support your brave choice to come forward to report abuse and scams in the industry. We know that coming forward is not simple 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 completely examine your claim, carefully prepare your case, for court, and work relentlessly with you and the federal or state government to help bring deceptive Medicare or Medicaid activity to justice.

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Whistleblower Laws in Montana

State governments rely on private whistleblowers with knowledge of Medicaid fraud to come forward to hold fraudulent activity in check and punish those who commit violations. A private individual who has knowledge of fraudulent activity against the Montana Medicaid program may have the right to file a whistleblower lawsuit under the Montana False Claims Act. 

 

A whistleblower, or qui tam lawsuit, is a civil suit on behalf of the state of Montana that holds those who conduct fraudulent activity accountable for their violations and recovers financial losses to the state. 

 

If the state of Montana joins the lawsuit and prosecutes the matter, the whistleblower may be awarded between 15 and 25 percent of their financial recovery. If the state declines to join the lawsuit, the whistleblower may be awarded between 25 and 30 percent of the recovery in addition to reimbursement of any costs associated with filling the suit.

 

The Montana False Claims Act also protects a whistleblower against any employer retaliation as a result of filing the lawsuit.

Liability of the Defendant in Montana

In Montana, the defendant can be ordered to pay up to three times the financial harm caused to the state in addition to penalties of between $5,500 and $11,000 per violation.

Statute of Limitations in Montana

A whistleblower must file a lawsuit within ten years of the violation date in order to be considered for a qui tam claim. 

Working With an Experienced Whistleblower Attorney

If you have become aware of fraudulent activity against the Montana Medicaid program, getting the legal advice of an experienced whistleblower attorney is critical. At Khurana Law Firm, P.C., we have over 20 years of experience in complex litigation, qui tam, and whistleblower law throughout the United States. Contact us for a confidential, no-cost consultation to discuss your case and understand your rights and options.

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 can report it 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. To report Medicare fraud, contact the experienced whistleblower lawyers at Khurana Law Firm, P.C. for a confidential consultation. 

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WORKING WITH An Experienced WHISTLEBLOWER ATTORNEY

If you’ve become aware of potential fraud that may involve Medicaid or Medicare, you need the guidance of an experienced whistleblower attorney, someone who can guarantee that your claim is completely investigated and filed accurately and promptly. By dealing with a skilled lawyer you are increasing the chance that the federal or state government will intervene, therefore increasing your chances for a reward. Reporting Medicare and Medicaid scams is a complicated matter –  don’t attempt 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 attorneys to assist in your fight against Medicare and Medicaid fraud. We will review your case on a confidential, no-obligation basis. If we feel that you have a valid claim, we can represent you in a qui tam claim to report the scams and allow you to gather a reward. 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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