In a report issued March 3, Suzanne Segal, a special master appointed by the court, said the government lacked evidence to support its claims.
Ms. Segal, a retired judge, was appointed as a special master in the case in 2020. The federal judge overseeing the case will decide whether to adopt Ms. Segal’s recommendation, according to Bloomberg.
The original lawsuit was filed in 2011 by a whistleblower, and the Justice Department joined the case in 2017, according to the Minnesota Star Tribune.
The government alleged UnitedHealth received $2.1 billion for Medicare Advantage diagnoses not supported by medical records between 2010 and 2017. The Justice Department failed to prove that the claims detailed in the case were not backed by medical records.
After more than a decade of litigation, the government did not review a single medical chart at issue in the case, Ms. Segal wrote.
“The government must now accept the consequences of that decision, which is that its experts are left hopelessly unable to say which (if any) of the diagnosis codes at issue are unsupported,” Ms. Segal wrote.
UnitedHealth shares jumped slightly after the decision, Bloomberg reported.
“After more than a decade of DOJ’s wasteful and expensive challenge to our Medicare Advantage business, the special master concluded there was no evidence to support the DOJ’s claims we were overpaid or that we did anything wrong,” UnitedHealth Group said in a statement to the Star Tribune.
The Justice Department is objecting to the decision, theTribune reported.
The Wall Street Journal reported Feb. 21 that the DOJ is investigating Medicare Advantage billing practices at UnitedHealth, a development that the insurer disputes. Shortly after, Sen. Chuck Grassley launched an inquiry into UnitedHealth’s MA billing practices.
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 the Inspector General.
