U.S. investigates four insurers over Medicare payments (updated)
17/03/2017 18:33
(Adds comment from Humana, Health Net and Aetna)
By Nate Raymond
March 17 (Reuters) - The U.S. Justice Department has
disclosed an investigation into four health insurers after a
lawsuit accused them of defrauding Medicare by claiming patients
were treated for conditions they did not have or received no
treatment for.
The probe of Health Net Inc MAHN.PK , Aetna Inc AET.N ,
Cigna Corp's CI.N Bravo Health Inc and Humana Inc HUM.N was
revealed in papers filed on Tuesday in federal court in Los
Angeles, in a lawsuit the government recently joined against
UnitedHealth Group Inc UNH.N .
The department last month partially intervened in the U.S.
False Claims Act lawsuit brought by a former UnitedHealth
executive, Benjamin Poehling, whose whistleblower case against
the company and other insurers was filed under seal in 2011.
Under the False Claims Act, whistleblowers can sue companies
on the government's behalf to recover taxpayer money paid out
based on fraudulent claims.
If successful, whistleblowers receive a percentage of the
recovery. A government decision to intervene is typically a
major boost to such cases.
When it initially intervened in the case in February, the
Justice Department said it was declining to pursue claims
against other insurers named in the lawsuit besides
UnitedHealth.
But on Tuesday, the Justice Department filed a "corrected
notice" of intervention, saying that, due to ongoing
investigations of Health Net, Aetna, Bravo and Humana, it could
not make a decision as to whether to proceed against them.
Humana spokesman Tom Noland said in an email the company had
previously disclosed the investigation in filings with the U.S.
Securities and Exchange Commission. Humana has said it would
cooperate with authorities.
UnitedHealth has said it rejects the allegations. A
spokesman had no immediate comment on Friday.
Aetna and Health Net declined to comment. Representatives
for Cigna did not respond to a request for comment on Friday,
nor did the Justice Department. A lawyer for Poehling had no
immediate comment.
Poehling's lawsuit accused UnitedHealth, Health Net, Aetna,
Bravo Health, Humana and other insurers of defrauding the United
States of hundreds of millions - and likely billions - of
dollars through claims for payments from the Medicare healthcare
program for the elderly. urn:newsml:reuters.com:*:nL1N1G200N
The lawsuit centered on "risk adjustment" payments that
Medicare makes to managed-care plans to offset the increased
costs associated with treating patients with multiple or serious
health conditions.
The lawsuit claimed that, in seeking those payments, the
insurers falsely claimed that patients were treated for
diagnoses they did not have or were not treated for.
The case is U.S. ex rel. Benjamin Poehling v. UnitedHealth
Group Inc et al, U.S. District Court, Central District of
California, No. 16-cv-08697.
(Reporting by Nate Raymond in Boston; Editing by Lisa Shumaker
and Richard Chang)
((Nate.Raymond@thomsonreuters.com and Twitter @nateraymond;
617-856-1312; Reuters Messaging:
nate.raymond.thomsonreuters.com@reuters.net))
Keywords: USA HEALTH/LAWSUIT