Feds Say UnitedHealth Wrote False Claims, Defrauded Medicare

UnitedHealthcare campus Minneapolis Photo: AP/Jim Mone
UnitedHealthcare campus Minneapolis

May 17, 2017 04:04 PM

The federal government has filed a lawsuit against UnitedHealth Group, Inc., claiming officials engaged in a widespread scheme dating back to 2006 to provide false claims.

Those claims are alleged to have made some Medicare beneficiaries appear more sick than they were in an attempt to receive more in payments. 


In documents filed in U.S. District Court in Los Angeles Tuesday, a former UnitedHealth whistleblower on behalf of the U.S. government also claims the insurer knew it was receiving overpayments from the Centers for Medicare and Medicaid Services as a result of false "risk adjustment submissions."

The lawsuit alleges the Minnetonka-based insurer violated the federal False Claims Act, and in so doing has defrauded the government of "hundreds of millions – likely billions – of dollars." 

The documents allege that because Medicare pays out more for sick members than healthy members, UnitedHealth engaged in "systematic fraud" in which they:

  • routinely submitted risk adjustment claims for diagnoses that an insured does not have, or for which the insured was not treated within an allotted time; 
  • refused to correct and reimburse to Medicare previously-submitted risk adjustment claims after discovering – or that they should have discovered – that those previously-submitted claims were false. 

The government names as a plaintiff in the suit Benjamin Poehling, a former risk-adjustment coordinator who left the insurer in 2012. A federal judge in February unsealed a lawsuit Poehling had filed against UnitedHealth and 14 other companies involved in Medicare Advantage, according to a New York Times report.

That suit is the basis for the documents filed by the federal government Tuesday in California.

UnitedHealth has not responded to a request for comment. 


Michael Oakes

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