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UnitedHealth Mischarged Millions from Medicare Advantage and Prescription Programs
UnitedHealth Group Inc. allegedly mischarged millions from Medicare Advantage and Prescription Programs in a scheme that spanned years, according to a federal complaint filed in Los Angeles.
The complaint, filed by the United States, alleges that UnitedHealth knowingly obtained inflated risk adjustment payments based on untruthful and inaccurate information about the health status of beneficiaries enrolled in its Medicare Advantage Plans throughout the United States.
United Health is the nation’s largest Medicare Advantage Organization, with more than 50 Medicare Advantage and Drug Prescription plans providing healthcare services and prescription drug benefits to millions of Medicare beneficiaries throughout the United States.
The risk adjustment payments are based, in significant part, on the health status of the beneficiary, which are reflected by diagnoses that UnitedHealth receives from treating physicians and subsequently submits to Medicare for each beneficiary.
The complaint alleges that UnitedHealth conducted a national Chart Review Program designed to identify additional diagnoses not reported by treating physicians that would increase its risk adjustment payments. However, UnitedHealth allegedly ignored information from these chart reviews showing that hundreds of thousands of diagnoses provided by treating physicians and submitted by it to Medicare were invalid and did not support the Medicare payments it had previously requested and obtained.
”To ensure that the program remains viable for all beneficiaries, the Justice Department remains tireless in its pursuit of Medicare fraud perpetrated by healthcare providers and insurers,” said Acting United States Attorney Sandra R. Brown. “The primary goal of publicly funded healthcare programs like Medicare is to provide high-quality medical services to those in need – not to line the pockets of participants willing to abuse the system.”
Acting Assistant Attorney General Chad A. Readler added, “The Department of Justice’s pursuit of this matter illustrates its firm commitment to ensure the integrity of the Medicare Program, including those parts of the program that rely on the services of Medicare Advantage Organizations.”
RELATED: UnitedHealth Accused of $Million Medicare Fraud Again
Key Facts
- State: California
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release â†â€â€
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