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Tuesday, September 17, 2019

Justice Department files second complaint against UnitedHealth Group alleging Medicare fraud

By Mark Iandolo | May 22, 2017

LOS ANGELES (Legal Newsline) — The U.S. Department of Justice announced May 16 that it has filed a second complaint against UnitedHealth Group Inc. (UHG) for allegations of knowingly obtaining inflated risk adjustment payments based on untruthful and inaccurate information about its UHG’s Medicare Advantage plan beneficiaries and their health statuses.

“The Department of Justice’s pursuit of this matter illustrates its firm commitment to ensure the integrity of the Medicare program, including those parts of the program that rely on the services of Medicare Advantage organizations,” said acting assistant attorney general Chad A. Readler of the Justice Department’s Civil Division.

The department says UHG, the nation’s largest Medicare Advantage organization, knowingly disregarded information about the medical conditions of beneficiaries. The company receives a monthly “risk adjustment” payment from Medicare for each enrolled beneficiary. These risk adjustments are based on health status, which is determined by treating physicians. UHG allegedly ignored the information and inflated the amounts.

“To ensure that the program remains viable for all beneficiaries, the Justice Department remains tireless in its pursuit of Medicare fraud perpetrated by health care providers and insurers,” said acting U.S. attorney Sandra R. Brown for the Central District of California. “The primary goal of publicly funded health care programs like Medicare is to provide high-quality medical services to those in need – not to line the pockets of participants willing to abuse the system.”

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