DOJ joins another lawsuit accusing UnitedHealth of Medicare fraud

The U.S. Department of Justice joined a second whistle-blower lawsuit against Minnetonka, Minn.-based UnitedHealth Group that alleges the insurer sought fraudulent Medicare Advantage payments, Kaiser Health News reports. 

The whistle-blower suit, filed by James Swoben in 2009, claimed UnitedHealth billed Medicare higher payments for patients by "making patients look sicker than they" were, the report states. DOJ officials filed an intervention in the lawsuit last week in a Los Angeles federal court.

The DOJ's decision to join Mr. Swoben's lawsuit follows a similar move in February, when the DOJ joined another whistle-blower lawsuit against UnitedHealth and its subsidiary WellMed Medical Management. That lawsuit alleges the payers used incorrect coding to increase Medicare Advantage risk scores. The allegations were originally presented by Benjamin Poehling, former finance director of UnitedHealthcare Medicare and Retirement. Mr. Poehling filed the U.S. False Claims Act lawsuit under seal in 2011.

On Monday, the DOJ expressed interest in combining Mr. Swoben's and Mr. Poehling's lawsuits. Mr. Swoben's attorney William Hanagami said the combined accusations could amount to one of the largest cases of Medicare fraud, totaling upward of $1 billion. 

UnitedHealth spokesperson Matt Burns told Kaiser Health News the payer denied the allegations and is "honored to serve millions of seniors through Medicare Advantage, proud of the access to quality health care we provided and confident we complied with program rules." 

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