Consumer Fraud

U.S. Investigating Medicare Fraud Claims Against Four Additional Insurers Named By UnitedHealth Whistleblower

Pills Stethascope on Money 435x289 U.S. Investigating Medicare Fraud Claims Against Four Additional Insurers Named By UnitedHealth WhistleblowerIn February, the U.S. Department of Justice (DOJ)  joined a False Claims Act lawsuit against UnitedHealth filed by a former executive who accused the company of cheating Medicare, but declined to intervene in allegations against more than a dozen other major insurers named as defendants.

Recently unsealed court documents, however, show that the federal government is investigating allegations of Medicare fraud against some of the other insurers named as defendants by whistleblower Benjamin Poehling, former finance director for UnitedHealth Medicare and Retirement, a subsidiary that works with the Medicare Advantage program.

In a court document filed March 14, the DOJ clarifies that it “has been conducting, and continues to conduct, ongoing investigations” of four of those insurers—Health Net, Aetna, Humana, and Bravo Health, a unit of Cigna.

“Until those investigations are completed, the United States cannot reach a decision about the liability of these other defendants under the False Claims Act … with respect to the truthfulness of their claims to the Medicare Program for risk adjustment payments, the truthfulness of their risk adjustment attestations to the Medicare Program, or their possible improper avoidance of returning overpayments.”

The Justice Department’s statements indicate that it may intervene in Mr. Poehling’s False Claims Act allegations against those insurers at a later time.

Mr. Poehling filed his False Claims Act whistleblower suit in federal court in Los Angeles in 2011. It remained under seal pending a federal investigation into his claims and became public on Feb. 16 after the Justice Department chose to intervene.

In the lawsuit, Mr. Poehling alleges that UnitedHealth and the other defendants “engaged in a widespread scheme to knowingly submit … false claims for payment to the United States by submitting false ‘risk adjustment’ information to the Centers for Medicare and Medicaid Services.”

Mr. Poehling alleges this “systematic fraud” allowed the insurers to overcharge Medicare by “hundreds of millions — and likely billions — of dollars.”

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