UnitedHealthcare improperly took money from Medicare, lawsuit says
UnitedHealthcare, one of the nation’s largest health insurers, may have improperly taken billions of dollars from Medicare by claiming for years that people under its care were sicker than they were, according to a lawsuit that was made public Thursday at the Justice Department’s request.
The accusations at issue in the suit center on Medicare Advantage, a program through which people 65 or older agree to join private health maintenance organizations, or HMOs, whose costs are reimbursed by the government.
The program was created in 2003 after UnitedHealthcare and other insurers said that managed care could help hold down the overall cost of Medicare, which has strained the federal budget by rising faster than the rate of inflation.
Instead of slowing Medicare costs, UnitedHealthcare may have improperly added excess costs running into the billions of dollars over more than a decade, according to documents unsealed in U.S. District Court in Los Angeles.
A spokesman for UnitedHealthcare was not immediately available for comment.
The allegations were first made in 2011, when a former UnitedHealthcare executive, Benjamin Poehling, filed a complaint under the False Claims Act, a federal law that lets private citizens take legal action when they believe a government program has been defrauded.
Such cases are typically filed under seal to give federal or state investigators time to follow up and decide whether to join the litigation.
In successful False Claims Act cases, where the government ultimately recovers money, the original whistleblower receives a portion.
Poehling’s complaint, which was among the documents unsealed Thursday, named 15 companies as defendants.
Of those, the Justice Department told the court it wanted to intervene in the cases against two, UnitedHealthcare and WellMed Medical Management, which UnitedHealthcare acquired in 2011.
The Justice Department asked the court to grant access to all documents produced as Poehling’s case proceeds.