U.S. probing insurers beyond UnitedHealth over Medicare charges
17/03/2017 17:06
By Nate Raymond
March 17 (Reuters) - The U.S. Justice Department disclosed
it is investigating four health insurers after a lawsuit accused
them of defrauding Medicare by claiming patients were treated
for conditions they either did not have or received no treatment
for.
The Justice Department revealed 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 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 Justice 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.
Representatives for Health Net, Aetna, Cigna and Humana did
not immediately 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.
UnitedHealth has said it rejects the lawsuit's allegations
and would contest them in court. A spokesman had no immediate
comment on Friday.
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 Anthony Lin
and Jonathan Oatis)
((Nate.Raymond@thomsonreuters.com and Twitter @nateraymond;
617-856-1312; Reuters Messaging:
nate.raymond.thomsonreuters.com@reuters.net))
Keywords: USA HEALTH/LAWSUIT