February 21, 2018 - Posts

Government Wins a Big Victory in Medicare Advantage Fraud Case

We’ve written before about two high profile cases that the United States has been pursuing against UnitedHealth Group, based on allegations that the company was categorizing its Medicare Advantage (i.e. Medicare Part C) patients as sicker than they really were in order to increase reimbursement from the United States.


In October, a federal judge dismissed one of those two related cases, raising questions about whether the Government’s theory of liability might be dead in the water.  But that no longer appears to be the case.  Last week, the federal judge in the remaining case – U.S. ex rel. Poehling v. UnitedHealth Group – denied the Defendant’s motion to dismiss, ruling that the Justice Department sufficiently alleged that UnitedHealth submitted invalid diagnostic data related to the health of its Medicare Advantage patients. While the judge dismissed a few of the Government’s theories of liability, the case as a whole can now proceed to discovery, which is a big win for both the United States and the whistleblower who initially brought the case.


U.S. Can Sue UnitedHealth in $1 Billion Medicare Case, Judge Rules


Fraud against the Medicare Advantage Program remains a cutting edge issue in the world of whistleblower and False Claims Act law, so this case is definitely going to be one to watch.


To learn more about our Whistleblower & Qui Tam practice click here.  Our firm is located in Nashville, Tennessee but we represent whistleblowers all around the country.

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