U.S. Sues UnitedHealth for $Billions in Medicare Fraud Scandal

The United States has filed a monumental lawsuit against health giant UnitedHealth Group, Inc., charging the company with bilking billions from Medicare. The allegations focus on inflated risk adjustment payments based on false and inaccurate data about beneficiaries in its largest Medicare Advantage Plan, UHC of California.

This complaint follows the government’s earlier intervention in February against UnitedHealth in a related case, United State ex rel. Poehling v. UnitedHealth Group Inc., also in Los Angeles. The Justice Department has set a deadline of May 16 for filing a complaint in that matter.

UnitedHealth, the nation’s largest Medicare Advantage Organization, is accused of ignoring medical condition information about beneficiaries, leading to increased Medicare payments. It is alleged that the company funded chart reviews by HealthCare Partners, a major service provider for UnitedHealth beneficiaries, to boost these payments while disregarding invalid diagnoses in the process.

Acting U.S. Attorney Sandra R. Brown emphasized the significance of this action, stating, ‘Medicare Advantage plans are taxpayer-funded and intended for beneficiary health. Our office will continue to hold accountable those who undermine the integrity of Medicare.’

The lawsuit was initially filed by James Swoben, a former employee and consultant to the risk adjustment industry, under the False Claims Act. The Act allows private parties to sue on behalf of the U.S. and receive a share of recoveries.

Acting Assistant Attorney General Chad A. Readler highlighted the government’s commitment to safeguarding Medicare Part C. This investigation was conducted by multiple departments, including the Civil Division’s Commercial Litigation Branch and the U.S. Department of Health and Human Services’ Office of Inspector General.