LOS ANGELES – For the second time in two weeks, the United States has launched a legal assault against UnitedHealth Group Inc., accusing the health insurance giant of deliberately defrauding the Medicare Advantage and Prescription Drug Programs.
In a gritty complaint filed today, the government alleges that UnitedHealth knowingly secured excessive risk adjustment payments from Medicare by presenting false and misleading data about the health status of its enrolled Medicare Advantage Plan beneficiaries across the nation.
United Health’s brazen tactics follow the previous filing earlier this month in United States ex rel. Swoben v. Secure Horizons, another lawsuit that accused the company of submitting false claims for payment to Medicare.
As the largest Medicare Advantage Organization in the U.S., UnitedHealth administers more than 50 plans, serving millions of beneficiaries. The risk adjustment payments are pegged largely on the health condition of each beneficiary, ascertained through diagnoses submitted to Medicare by treating physicians. However, the lawsuit asserts that UnitedHealth disregarded critical medical information, leading to inflated payments.
The complaint reveals that UnitedHealth’s Chart Review Program, intended to pinpoint additional diagnoses not reported by physicians, was ignored by the company despite evidence of invalid diagnoses. By doing so, the firm dodged repayment of Medicare funds it wasn’t entitled to receive.
Acting United States Attorney Sandra R. Brown emphasized the Justice Department’s relentless pursuit of Medicare fraud, stating that the program should prioritize high-quality medical services for beneficiaries, not enrich participants who exploit the system.
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Key Facts
- State: California
- Agency: DOJ USAO
- Category: Fraud & Financial Crimes
- Source: Official Source ↗
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