The Justice Department announced today, that the United States has intervened and filed a complaint in a lawsuit against UnitedHealth Group Inc (UHG), alleging the Company obtained inflated risk adjustment payments based on untruthful and inaccurate information about the health status of beneficiaries enrolled in UHG's largest Medicare Advantage Plan, UHC of California.
According to the United States, allegedly UHG knowingly disregarded information about beneficiaries' medical conditions, which increased the payments UHG received from Medicare.
“Since 2005, UnitedHealth knew that many diagnosis codes that it submitted to the Medicare Program for risk adjustment were not supported and validated by the medical records of its enrolled beneficiaries,” according to the complaint. In February, the United States joined a related lawsuit filed by a whistleblower in California alleging that UnitedHealth defrauded the Medicare program.
“Medicare Advantage plans not only receive taxpayer-funded payments, but are intended for the health and welfare of the beneficiaries,” said Acting U.S. Attorney Sandra R. Brown for the Central District of California. “This action sends a warning that our office will continue to scrutinize and hold accountable Medicare Advantage insurers to safeguard the integrity of the Medicare program.”
The lawsuit was brought forward by a former employee of Senior Care Action Network Health Plan and a consultant to the risk adjustment industry, James Swoben, who will receive a share of any recovery.
