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DOJ Claims UnitedHealth Group Overbilled Medicare by Hundreds of Millions

The U.S. Department of Justice recently sued UnitedHealth Group, claiming the company’s senior executives were aware it was overbilling Medicare by hundreds of millions of dollars annually and that they put a stop to a repayment plan in 2014 to meet revenue expectations.

The official complaint was filed in May in the U.S. District Court in Los Angeles. In the complaint, the Justice Department alleges UnitedHealth regularly searched for data in patient charts the company could use to make them look sicker than they really were meant to justify larger Medicare payouts.

Through the Medicare Advantage program, reports of unhealthier patients leads to larger payments from the federal government. Between 2010 and 2015 alone, UnitedHealth received $3 billion from the federal government. Misrepresenting patient health is considered healthcare fraud, and in this case, the Justice Department is seeking triple damages and various other penalties.

A spokesperson from UnitedHealth said the lawsuit indicates that the Justice Department has a fundamental misunderstanding of how Medicare Advantage works, and that reviewing patient information and correcting errors is “an appropriate and expected part of the Medicare Advantage program.”

Agency joins a whistleblower suit already filed

By filing this complaint, the Justice Department joins a lawsuit already filed against UnitedHealth by a former employee of the company, who worked there from 2002 to 2012. The whistleblower filed his claim in 2011 under the False Claims Act, which allows private citizens to file lawsuits on behalf of government agencies they believe have been defrauded. The lawsuit was made public in February when the Justice Department announced its decision to join the litigation.

Government agencies joining these types of lawsuits is generally a good sign for whistleblowers. For more information and guidance on how to file a False Claims Act lawsuit and the various other legal opportunities available to you, meet with an experienced Dallas attorney at Whistleblower Law for Managers.

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