A whistleblower has made claims that UnitedHealth Group, a Minnesota-based company, has committed Medicare fraud by submitting false information related to patient conditions.
If the claim is true, it could mean that the large healthcare provider defrauded the program out of hundreds of millions of dollars over the course of several years. The whistleblower says that UnitedHealth Group’s malfeasance was focused mostly on Medicare Advantage health plans offered by private insurers to manage healthcare for individuals receiving Medicare benefits.
Insurers that offer Medicare health plans pay physicians and hospitals when their enrollees receive healthcare services. Then, the federal government pays the insurers a set rate per month for each member enrolled. The government provides more money to insurers that cover people with conditions that are more expensive to treat, in an arrangement referred to as “risk adjustment.”
A lawsuit is now underway
The federal government has joined the plaintiff’s lawsuit, which claims that the insurance companies working with UnitedHealth Group increased their risk adjustment claims by submitting forms for diagnoses patients had not actually received.
UnitedHealth Group has denied any allegations that it was involved with alleged overpayments in any way. A spokesperson said the company would aggressively fight the lawsuit.
Medicare fraud is a common type of wrongdoing whistleblowers uncover on a regular basis within businesses and organizations across the United States. If you believe you have a claim or need assistance during an internal investigation, meet with an experienced Dallas attorney at Whistleblower Law for Managers right away.