Whistle-Blower Suit: UnitedHealth Group Overcharged in its Medicare Advantage Plans

UnitedHealth Group owns the biggest share of the Medicare Advantage market (21%), according to the Kaiser Family Foundation. It’s been a lucrative niche for the giant insurer, but has it been too lucrative? The Justice Department recently made public a whistle-blower lawsuit that claims that that the health plan overcharged Medicare by saying that millions of MA beneficiaries were sicker than they actually were, according to the New York Times. The company defrauded Medicare by possibly billions of dollars, the suit alleges.

UnitedHealth Group denies the allegations and vows to fight the lawsuit, with spokesman Matthew A. Burns telling the newspaper that the insurer is “proud of the access to quality health care we provided, and confident we complied with the program rules…. We reject these more than five-year-old claims and will contest them vigorously.”  

The accusations that were unsealed last Thursday were made by Benjamin Poehling, a former UnitedHealth Group employee, in 2011. He filed under the False Claims Act, which allows private citizen to take legal action when he believes that a government program has been defrauded.  

That the allegations had been sealed is typical in such cases, the Times reports, as it allows government investigators to weigh the merits. In successfully prosecuted cases, the whistle-blower often receives a share of the settlement. The Justice Department “is intervening in the whistle-blower’s claims about erroneous coding and inflated billing but is not taking part in other claims. The government has 90 days to file its own complaint.”

Source: New York Times