United Health Group accused of overbilling Medicare by $1B

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The justice department has accused insurance giant United Health Group overcharging the federal government by more than $1B through its Medicare Advantage plans.  The 79-page lawsuit filed Tuesday in Los Angeles alleges the insurer made patients appear sicker than they were to collect higher Medicare payments than the company deserved.  The government said it had “conservatively estimated” the company “knowingly and improperly avoided repaying Medicare” for more than a billion dollars over the course of the alleged decade-long scheme.

This filing marks the second time that the Justice Department has intervened to support a whistleblower suing United Health under the federal False Claims Act.  Earlier this month, the government joined a similar case brought on by California Whistleblower James Swoben, a medical data consultant, also alleges that UnitedHealth overbilled Medicare.

United is the nation’s largest operator of Medicare Advantage plans; it covers about 3.6 million patients in 2016 when Medicare paid the company $56B.  Advantage plans are alternatives to Medicare’s traditional fee-for-service options.

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