Khurana
Law Firm

Medicare whistleblower lawyer

Whistleblower and qui tam attorneys battling Medicare and Medicaid scams in New Mexico

Medicare and Medicaid fraud cost New Mexico taxpayers billions of dollars each year. While the majority of medical service providers and drug companies are honest and work within the legal channels, some do not. When fraud takes place, everybody can lose. Medicaid and Medicare whistleblower attorneys assist healthcare workers to file suits on behalf of the federal or state government to report this sort of fraud.

The state and federal government put a a good deal of trust in medical and pharmaceutical companies. When that trust is ill-placed, the government relies on private citizens in New Mexico to come forward and to report scams. People like you.

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Experienced Medicaid and Medicare whistleblower lawyers; representing healthcare employees in New Mexico

At Khurana Law Firm, P.C., as knowledgeable Medicare and Medicaid whistleblower legal representatives, we support your heroic choice to come forward to report abuse and scams in the industry. understand 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 .

With our comprehensive experience representing whistleblowers nationwide, we thoroughly examine your claim, diligently and carefully prepare your case, and work relentlessly with you and the state of federal government to help bring fraudulent Medicaid or Medicare activity to justice.

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Whistleblower Laws in New Mexico

In the state of New Mexico, there are laws that hold those who perpetrate fraud against the state liable for their actions. Under the New Mexico Medicaid False Claims Act and the New Mexico Fraud Against Taxpayers Act, a whistleblower who has knowledge of fraudulent activity against the state has the ability to file a qui tam lawsuit against the wrongdoer on behalf of the state. 

 

The New Mexico Fraud Against Taxpayers Act holds parties liable who engage in various fraudulent activity against the state, including fraudulently presenting false claims for payment to the state, misappropriating property of the state or political subdivision, deceptively avoiding paying the state or political subdivision, as well as other actions. 

 

The New Mexico Medicaid False Claims Act holds parties liable who knowingly submit false claims to New Mexico’s Medicaid program.

 

Whistleblowers who file a successful qui tam lawsuit are entitled to receive between 15 and 25 percent of the recovery if the state becomes party to the suit. If not, the individual can proceed independently and be awarded between 25 and 30 percent of the successful recovery. 

 

A whistleblower is also afforded protection from employer retaliation as a result of filing suit or assisting in the state’s recovery.

Liability of the Defendant in New Mexico

A defendant in a qui tam lawsuit in New Mexico may be ordered to pay up to three times the harm to the state under the New Mexico Medicaid False Claims Act. Under the New Mexico Fraud Against Taxpayers Act, the defendant may be ordered to pay up to three times the harm to the state in addition to penalties of between $5,000 and $10,000 per violation.

Working With an Experienced Whistleblower Attorney

If you are aware of fraudulent activity against the state of New Mexico, you may be able to file a whistleblower civil lawsuit on behalf of the state and be rewarded for your heroic efforts. At Khurana Law Firm, P.C., our experienced whistleblower attorneys can help you understand your rights and options under the law. Contact us for a 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 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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Work With A NATIONALLY RECOGNIZED WHISTLEBLOWER ATTORNEY

If you’ve become aware of fraudulent activity involving Medicaid or Medicare, you require the guidance of a knowledgeable whistleblower lawyer, someone who can make sure that your claim is completely investigated and submitted accurately and without delay. By dealing with a skilled attorney you are increasing the chance that the government will step in, therefore increasing your chances for a financial reward. Reporting Medicaid and Medicare 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 practical experience as national qui tam legal representatives to help in your fight against Medicare and Medicaid scams. We will examine your case on a confidential, no-obligation basis. If we feel that you have a legitimate claim, we may represent you in a qui tam suit to report the scams and allow you to gather a reward. All whistleblower work is on contingency, you pay absolutely nothing up until there is a recovery. Get in touch with us today to learn how we can be of help.

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