DOJ sues UnitedHealth over $1B+ in Medicare claims


http://www.beckershospitalreview.com/payer-issues/doj-sues-unitedhealth-over-1-billion-in-medicare-false-claims-again.html

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The Justice Department sued Minnetonka, Minn.-based UnitedHealth Group Tuesday, alleging the payer defrauded Medicare at least $1 billion in false claims.

In the 103-page lawsuit filed in a Los Angeles federal court, the Justice Department alleged the payer knowingly inflated risk adjustment payments by providing the government inaccurate data about the health status of its beneficiaries. Department officials cited UnitedHealth’s “one-sided” chart review process that reportedly didn’t address errors elevating its revenues.

The department also alleges the payer ignored “invalid diagnoses from healthcare providers with financial incentives to furnish such diagnoses.

The move follows the department’s decision to intervene in a whistle-blower suit filed by James Swoben in 2009. That suit alleges UnitedHealth billed Medicare higher payments for patients by “making patients look sicker than they” were. In an earlier statement to Star Tribune, UnitedHealth spokesperson Matt Burns said the payer denied the claims and has “been transparent with [CMS] about our approach under its unclear policies. We reject these claims and will contest them vigorously.”

This is the second lawsuit the department has filed against the insurer this month. The other lawsuit concerns separate but similar allegations filed under seal in 2011 by Benjamin Poehling, former finance director of UnitedHealthcare Medicare and Retirement.

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