DOJ Accuses UnitedHealth of Medicare Advantage Fraud

WASHINGTON (CN) – The Justice Department sued UnitedHealth Group Inc. in federal court, claiming the country’s largest health insurer obtained inflated payments from the government based on inaccurate information about the health status of patients enrolled in its Medicare Advantage Plan.

The lawsuit, filed in Los Angeles on Monday, follows the DOJ’s intervention in a pair of whistleblower lawsuits against UnitedHealth Group earlier this year.

According to the 39-page complaint, since at least 2005, UnitedHealth knew many of the diagnosis codes it submitted to the Medicare program for increased payments — codes based on risk factors like patient health status — were not supported by patients’ medical records.

But it did nothing to correct the information, and in fact encouraged the erroneous, one-sided chart reviews of patients of HealthCare Partners, which provided services to UnitedHealth beneficiaries in California.

As a result, the Justice Department says, UnitedHealth avoided repaying Medicare for money it wasn’t entitled to.

“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 Brown in a written statement.

“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,” Brown said.

The filing of the lawsuit came as the House Subcommittee on Oversight and Investigations preparing to discuss a range of  waste, fraud and other issues plaguing a sister program to Medicare, Medicaid Personal Care Services.

On Tuesday morning, the committee reviewed reports compiled by the Department of Health and Human Services, the Office of the Inspector General and the Government Accountability Office that found rampant

complaints of prescription pill theft, elder abuse by in-home attendants and other systemic woes in more than 200 abuse cases filed since 2012.

OIG Chief of Staff Christi Grimm said her findings also uncovered falsified timesheets by providers bilking their wards and their families.

Grimm urged states to consider a more modern way to fend off abuses to the system.

“We should require states to enroll care attendants so we can track what happens,” she said.

Timothy Hill, deputy director for the Center for Medicaid and CHIP Services, and Katherine Iritani, director of health care for the GAO, agreed that a central database of providers would ease the pressures mounting inside the current “patchwork” system.

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