On Tuesday, for the second time in a month, the U.S. Justice Department sued UnitedHealth Group Inc. Justice department accused the nation’s largest health insurer of mischarging Medicare advantage and obtaining over $1 billion to which it was not eligible.
Justice Department Sues UnitedHealth – The Highlights
1. The complaint against UnitedHealth was filed in the federal court in Los Angeles. This second lawsuit came after the Justice Department brought a distinct yet similar case against the health insurer. In both the cases, the government intruded in whistleblower proceedings against them.
2. After the Justice Department interceded in a lawsuit brought by Benjamin Poehling (former UnitedHealth executive), whose whistleblower case was filed under seal in the year 2011 is when the latest complaint came.
3. The insurer did not make any comments on the claims. But previously they rejected the claims in the underlying whistleblower lawsuit and said they would fight the claims.
UnitedHealth Mischarged Medicare Advantage
Medicare is a government-run health insurance program which serves more than 50 million elderly or disabled Americans. More than one-third of this population are in Medicare Advantage plans which are run by private insurers like UnitedHealth.
Based on dishonest and inexact information about the health status of patients enrolled in its Medicare Advantage plans UnitedHealth obtained inflated risk adjustment payments- alleges the Justice Department.
UnitedHealth’s conduct damaged the Medicare program by over $1.14 billion from the year 2011 to 2014 said the lawsuit.
The Justice Department intends to charge triple damages under the False Claims Act as well as penalties.
Poehling Lawsuit
Poehling had filed his lawsuit under the False Claims Act. This act allows the whistleblowers to sue companies on behalf of the government to recover taxpayer money paid out based on fake claims.
If one wins the case, the whistleblowers would receive a percentage of the recovery.
Along with UnitedHealth, Poehling also sued other insurers. He claimed that they along with United Health had defrauded the United States.
However, Justice Department has not chased the claims against other companies. It is said that they have been investigating Centene Corp’s Health Net Inc, Aetna Inc, Cigna Corp’s Bravo Health Inc and Humana Inc. in the month of march.
Date: 18 May, 2017