New York NY - Medicare fraud is a huge problem in our country today. The vast size of the program requires that nearly a billion health care claims annually are submitted by Medicare providers. The program relies on the trustworthiness of those providers to properly file and administer claims within the rules. This has resulted in a hotbed for Medicare fraud. Consequently, there has become a continuing need for more Medicare whistleblower attorneys like Arvind Bob Khurana, Esq., founding attorney at the Khurana Law Firm, P.C., to represent people who come forward with knowledge of fraudulent Medicare activity.
The CMS (Center for Medicare and Medicaid Services) must contract with outside companies to process claims and determine whether the providers are submitting those claims in compliance with the rules. These outside contractors are the ones who are ultimately being tasked to administer the payments from Medicare, interpret the rules, and police the industry.
“Because of the size of the Medicare program, they have to get outside assistance to administer the sheer number of claims that come through the program on a daily basis. This requires them to rely on many different contractors to process claims and to make determinations whether the claim or service is medically necessary or whether the provider followed the rules set up by the CMS. When you have so many entities administering a program and the high number of claims being submitted, you have the opportunity for fraud,” Mr. Khurana explained. “Unfortunately, this is a system based in large part on trust. With the sheer amount of claims going through the system, following up on the validity of individual claims is difficult. The program then becomes ripe for criminal and fraudulent activity.”
Although the healthcare industry has been set up for efficiency in many respects, there are gaps in oversight in others. The many ways that the coding system itself can be used fraudulently is just one of the ways that fraud can occur within the system. Violations can result in civil penalties and even criminal charges if intentional fraud is uncovered.
“The government relies heavily on whistleblowers coming forward to report fraudulent Medicare activity,” Mr. Khurana continued. “These individuals can come forward by filing a qui tam lawsuit under the False Claims Act, which protects them individually as well as provides financial incentive. A whistleblower can collect substantial rewards for bringing fraudulent activity to light. We believe that these individuals are modern-day heroes and that their representation and protection are paramount.”
Arvind Bob Khurana, Esq. and the Khurana Law Firm, P.C. bring years of experience as nationally-recognized Medicare whistleblower attorneys to the table. To learn more about them and whistleblower law, go to their website at http://www.medicarewhistleblowercenter.com/.
SOURCE: Press Advantage [Link]
The Khurana Law Firm, P.C. has extensive experience representing whistleblowers nationwide and in investigating and filing lawsuits under the False Claims Act.
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