U.S. Sues Major Health Provider for Medicare Fraud

The U.S. Department of Justice recently joined a lawsuit against UnitedHealth Group, Inc. The suited, filed under the False Claims Act, alleges that UnitedHealth “inflated risk adjustment payments based on untruthful and inaccurate information about the health status of beneficiaries enrolled in [its] largest Medicare Advantage Plan…”
The complaint alleges that UnitedHealth knowingly disregarded information about beneficiaries’ medical conditions, which increased the payments received from Medicare. This is a significant action since UnitedHealth is the largest Medicare Advantage Organization in the country. The case was brought by whistle-blower under the FCA in 2009. The Department of Justice has a statutory right to intervene in such cases. Generally, the DOJ will intervene only after it has thoroughly investigated the case
The lawsuit alleges that UnitedHealth reported underpayments of benefits but did not report over-payments, as it was required to do under Medicare law.
The lawsuit indicates a trend towards greater scrutiny of Medicare Advantage Organizations and their billing practices. The DOJ’s press release is here: United States of America ex rel. Benjamin Poehling v. UnitedHealth Group, Inc.