Khurana
Law Firm

Medicare whistleblower lawyer

Whistleblower and qui tam lawyers battling Medicare and Medicaid scams in Pittsburgh, Pennsylvania

Medicaid and Medicare fraud cost Pennsylvania taxpayers billions of dollars annually. While many medical companies and drug companies are ethical and work within the system, there are those who don’t. When scams are perpetrated, everybody can lose. Medicaid and Medicare whistleblower lawyers help healthcare professionals to file claims on behalf of the federal or state government to report this type of fraud.

The federal and state governments put a good deal of trust in pharmaceutical and medical service providers. When that trust is ill-placed, the government depends on every day people in Pennsylvania to come forward and to report fraud. People like you.

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Experienced Medicaid and Medicare whistleblower attorneys; representing healthcare workers in Pittsburgh, Pennsylvania

At Khurana Law Firm, P.C., as experienced Medicare and Medicaid whistleblower legal representatives, we support your heroic choice to come forward to report abuse and scams in the industry. understand that stepping forward is challenging and lots of things might be at stake. When you come to us, your case is held in the strictest confidence at all times.

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

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Whistleblower Laws in Pittsburgh, Pennsylvania

While taxpayers help fund Medicaid in order to permit low-income healthcare for those who need it, there are unethical people and business entities who defraud the state of Pennsylvania’s Medicaid program through deceptive activity. These activities have actually cost the government countless dollars. State resources committed to the discovery of fraud are limited and, subsequently, the state should count on healthcare providers and others to report any knowledge of scams.

 

Under the federal False Claims Act, individuals who know of deceitful activity against the government have the ability to submit a whistleblower suit to hold these parties responsible. Under the Act, an individual who brings a whistleblower claim is entitled to a benefit between 15 percent and 25 percent of any recovery, based upon their knowledge and contributions. If the government selects not to intervene in the action, the whistleblower might get in between 25 and 30 percent of the recovery.

 

Whistleblower laws use included staff member protection to avoid an employer from retaliating, discharging, threatening, or victimizing a whistleblower.

Liability of the Defendant in Pittsburgh, Pennsylvania

Infractions under the federal False Claims Act may lead to fines and penalties in the amount of 3 times the harm to the government in addition to additional penalties of up to $5,500 to $11,000 for each infraction.

Statute of Limitations in Pittsburgh, Pennsylvania

Under the federal False Claims Act, a whistleblower claim need to be commenced within 3 years of the date of finding the deceptive activity and within 6 years after the activity occurred, whichever took place later, however not more than 10 years after the activity took place.

Working With an Experienced Whistleblower Attorney

If you suspect deceptive activity as it concerns the Medicaid program in Pittsburgh, Pennsylvania, getting assistance from a skilled whistleblower lawyer is essential. At Khurana Law Firm, P.C., we will help you figure out if you have a valid whistleblower claim and help you understand your rights and choices. Contact us for a confidential, no-cost assessment 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 Pittsburgh, Pennsylvania, 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 Pittsburgh, Pennsylvania,  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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Work With A NATIONALLY RECOGNIZED WHISTLEBLOWER LAWYER; We are proud to represent healthcare workers in Pittsburgh, Pennsylvania

When you become aware of fraudulent activity that may involve Medicaid or Medicare in Pittsburgh, Pennsylvania, you need the guidance of a skilled whistleblower attorney, someone who can ensure that your claim is completely investigated and filed accurately and quickly. By dealing with an experienced attorney you are increasing the chance that the government will intervene, therefore increasing the opportunity for a financial reward. Reporting Medicare and Medicaid fraud is a complicated matter –  do not attempt to do this alone, we are here to help.

At Khurana Law Firm, P.C., we have years of experience as national qui tam lawyers to assist in your fight against Medicaid and Medicare fraud. We will review your case on a confidential, no-obligation basis. If we feel you have a legitimate claim, we may represent you in a qui tam suit to help report the scams and enable you to collect a financial benefit. Because all whistleblower cases are on contingency, you pay nothing until there is a settlement. Get in touch with us today to learn how we can be of help.

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