The Justice Department is urging a federal court to allow a decade-old lawsuit against UnitedHealth Group to continue.
In documents filed April 2 in the U.S. District Court for the Central District of California, Justice Department attorneys argued that a court-appointed special master was incorrect in her recommendation to throw out the lawsuit, alleging UnitedHealth Group overcharged the federal government through Medicare Advantage claims.
The case was first filed in 2011, and the Justice Department joined the case in 2017. The government alleged that between 2010 and 2017, UnitedHealth received $2.1 billion for MA diagnoses not supported by medical records.
In March, Suzanne Segal, a retired judge appointed by the court to evaluate the case, recommended the case be thrown out, writing that the federal government failed to prove that the claims detailed in the case were not backed by medical records.
Claims the government failed to submit enough evidence to support its case are wrong, the Justice Department argued.
“The United States submitted evidence that United’s own coders had reviewed
the medical records at issue and did not find support for 1.97 million diagnosis codes,” the attorneys wrote.
Medicare Advantage plans are reimbursed by the federal government based on beneficiaries’ health risk status. Nearly every major Medicare Advantage plan has been accused of, or settled, allegations of upcoding, or making patients appear sicker than they are to receive higher reimbursements from the government.
Medicare Advantage companies brought in $7.5 billion in “questionable” payments in 2023, according to a 2024 report from HHS’ Office of Inspector General.
Becker’s has reached out to UnitedHealth Group for comment and will update this article if more information becomes available.
