Feds accuse insurer of $1 billion overcharging

Justice Department accuses carrier of doctoring claims

Feds accuse insurer of $1 billion overcharging

Life & Health

By Allie Sanchez

UnitedHealth Group is in hot water over accusations by the Justice Department that it overcharged the federal government more than $1 billion through its Medicare Advantage plans.

The Department filed a complaint with a Los Angeles court, alleging that the insurer made patients appear more infirmed than they actually were so it could collect higher payments from Medicare than what was actually due to the firm.

A Salon.com report said that the government has “conservatively estimated” that UnitedHealth “knowingly and improperly avoided repaying Medicare” more than a billion dollars in overcharged bills in the decade long course of the program.

“To ensure that the program remains viable for all beneficiaries, the Justice Department remains tireless in its pursuit of Medicare fraud perpetrated by healthcare providers and insurers,” acting US Attorney Sandra R. Brown said in the report.

“The primary goal of publicly funded health care programs like Medicare is to provide high quality services to those in need—not to line the pockets of participants willing to abuse the system,” she went on to say.

The filing is the second time the Justice Department stepped in to support a whistleblower suing United Health under the federal False Claims Act, the report also said. The department is pursuing a case originally filed in 2011 by Benjamin Poehling, a former finance director for the UnitedHealth division that oversees the Medicare Advantage plans.

Under the False Claims Act, private individuals can sue on behalf of the federal government and receive a share of the monies recovered from the case.

Prior to the Tuesday filing, the Justice Department also lent its support to a similar case filed by California whistleblower James Swoben in 2009. Swoben, who works as a medical data consultant, also alleged that UnitedHealth overbilled Medicare.

UnitedHealth is the country’s biggest Medicare Advantage participant, providing coverage to 3.6 million policyholders in 2016 - the time when Medicare paid the insurer $56 billion, the complaint said.

The firm denied wrongdoing and said it would contest the case.

“We are confident our company and our employees complied with the government’s Medicare Advantage program rules, and we have been transparent with (Centers for Medicare and Medicaid Services) about our approach under its unclear policies,” UnitedHealth spokesman Matt Burns was quoted as saying in a statement.

A spokesperson for CMS declined to comment. CMS has been under fire from Congress recently for its alleged oversight of the program, Salon reported.

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