DOJ Joins Potential $1 Billion Medicare Fraud Case

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The Justice Department has joined a California whistleblower’s lawsuit that accuses insurance giant UnitedHealth Group of fraud in its popular Medicare Advantage health plans, the Center for Public Integrity reports. Justice officials filed papers to intervene in the suit, first brought by whistleblower James Swoben in 2009, in federal court in Los Angeles. On Monday, they sought a court order to combine Swoben’s case with that of another whistleblower. Swoben has accused the insurer of “gaming” the Medicare Advantage payment system by “making patients look sicker than they are,” said his attorney, William Hanagami. Hanagami said the combined cases could prove to be among the “larger frauds” ever against Medicare, with damages that he speculates could top $1 billion.

UnitedHealth spokesman Matt Burns denied any wrongdoing by the company. Medicare Advantage is a popular alternative to traditional Medicare. The privately run health plans have enrolled more than 18 million elderly and people with disabilities — about a third of those eligible for Medicare — at a cost to taxpayers of more than $150 billion a year. Although the plans enjoy strong support in Congress, they have been the target of at least a half-dozen whistleblower lawsuits alleging patterns of overbilling and fraud. In most previous cases, Justice Department officials have decided not to intervene, which often limits the financial recovery by the government and also by whistleblowers, who can be awarded a portion of recovered funds. A decision to intervene means that the Justice Department is taking over investigating the case, greatly raising the stakes. “This is a very big development and sends a strong signal that the Trump administration is very serious when it comes to fighting fraud in the health care arena,” says Patrick Burns of Taxpayers Against Fraud in Washington, D.C.

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