A group of lawmakers is urging a federal court to allow a lawsuit alleging UnitedHealth Group overcharged the federal government for Medicare Advantage claims to continue.
Led by Washington Rep. Pramila Jayapal, 29 U.S. representatives signed on to an amicus brief filed May 15. The lawmakers argued the nearly decade-old case should proceed to a jury trial.
The case, filed in the U.S. District Court for the Central District of California, was first filed by a whistleblower in 2011, and the Justice Department joined the case in 2017. The government alleged that between 2010 and 2017, UnitedHealth received $2.1 billion in Medicare Advantage payments for diagnoses not supported by medical records.
In March, a special master, a retired judge appointed by the court to evaluate the case, recommended it be thrown out. The special master argued the federal government failed to provide evidence the claims at question in the cases were not backed by medical records.
The Justice Department has urged the court to allow the case to continue.
In the amicus brief, attorneys representing the lawmakers argued that throwing out the case would “set a negative precedent.”
“A ruling in favor of United would dispose of the present case prematurely before a jury has the opportunity to weigh in on United’s conduct, and would embolden other insurers to continue gaming the MA program with practices that harm American taxpayers and the elderly,” 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 — the practice of making patients appear sicker than they are to receive higher reimbursements from the government.
The case pertains to UnitedHealth Group’s conduct between 2010 and 2017, but the insurer has faced further investigations into its Medicare Advantage practices. In May, The Wall Street Journal reported UnitedHealth Group is under criminal investigation for alleged MA fraud. The exact nature of the allegations are unclear, the outlet reported.
UnitedHealth Group disputed the Journal’s reporting. In a May 14 statement, the company said it has not been notified by the Justice Department of any criminal investigation.
“The WSJ’s reporting is deeply irresponsible, as even it admits that the ‘exact nature of the potential criminal allegations is unclear,'” the company said. “We stand by the integrity of our Medicare Advantage program.”
