Khurana
Law Firm

Medicare whistleblower lawyer

Whistleblower and qui tam lawyers fighting Medicare and Medicaid fraud in Edinburg, Texas

Medicare and Medicaid fraud cost Texas taxpayers billions of dollars every year. While most medical service providers and drug companies are honest and work within the legal channels, there are those who do not. When scams are perpetrated, everybody can lose. Medicaid and Medicare whistleblower lawyers help people who work in the healthcare system to file lawsuits on behalf of the federal or state government to help report this sort of fraud.

The federal and state government place a lot of trust in pharmaceutical and medical providers. When that trust is ill-placed, the government relies on private citizens in Texas to come forward and to report scams. People like you.

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Experienced Medicare and Medicaid whistleblower attorneys; representing health care employees in Edinburg, Texas

At Khurana Law Firm, P.C., as experienced Medicare and Medicaid whistleblower attorneys, we support your brave decision to come forward to report abuse and scams in the industry. We know that coming forward is challenging 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 extensive experience representing whistleblowers nationwide, we thoroughly examine your claim, diligently prepare your case, and work relentlessly with both you and the federal or state government to help bring deceitful Medicaid or Medicare activity to justice.

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Whistleblower Laws in Edinburg, Texas

Private citizens who know of fraudulent activity against the state of Texas may have whistleblower rights under 2 state statutes.

 

The Texas Medicaid Fraud Prevention Act holds those entities accountable who have sent fraudulent claims and perpetuated unlawful acts against the Texas Medicaid program.

 

A whistleblower might file a qui tam suit on behalf of the state when they have proof of Medicaid fraud. Under the Texas Medicaid Fraud Act, the whistleblower in a successful action may be rewarded an amount between 15 and 25 percent of the recovery when the state elects to participate in the suit. If the individual pursues the lawsuit independent of the state, they might be granted between 25 and 30 percent of the funds recovered.

 

A separate provision likewise exists that offers an award to an individual who reports deceptive activity in the Texas Medicaid program without bringing a qui tam suit. If the report leads to the recovery, the award is restricted to five percent of the administrative charge imposed on the party committing the scams.

 

The Texas Whistleblower Act protects public workers from retaliation from any agency that utilizes them if they report wrongdoing. This law does not afford protection for employees who work for private companies.

Liability of the Defendant in Edinburg, Texas

The offender in a successful qui tam suit under the Texas Medicaid Fraud Prevention Act may be liable for charges of between $5,500 and $11,000 per infraction. If the unlawful conduct caused harm to the elderly, handicapped, or a minor, the defendant might be liable for charges of in between $5,500 and $15,000.

 

Statute of Limitations in Edinburg, Texas

The whistleblower has to submit their complaint within 6 years of the date of the infraction.

Working With an Experienced Whistleblower Attorney

Medicaid fraud cost federal and state governments and taxpayers billions of dollars each year. To help root out this problem, the state and federal government counts on the assistance of whistleblowers and rewards them for their heroic efforts.

 

If you have proof of Medicaid scams in Edinburg, Texas, you might have the right to pursue a qui tam claim and collect a monetary reward. At the Khurana Law Firm, we represent whistleblowers who help states in holding culprits accountable. Contact us today to arrange a confidential consultation in order to discuss your case and understand your rights and protections under Texas whistleblower laws.

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 Edinburg, Texas, 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 Edinburg, Texas,  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 Edinburg, Texas

When you become aware of potential fraud that may concern Medicare or Medicaid in Edinburg, Texas, you require the advice of an experienced whistleblower lawyer, someone who can make sure that your claim is totally examined and submitted accurately and without delay. By dealing with an experienced lawyer you are increasing the chance that the government will step in, therefore increasing the chance for a reward. Reporting Medicaid and Medicare fraud is a complex matter –  do not 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 lawyers to help in your fight against Medicaid and Medicare 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 help report the fraud and allow you to gather a reward. Because all whistleblower work is on contingency, you pay nothing up until there is a recovery. Contact us today to learn how we can help.

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