The Department of Justice announced yesterday that it has filed a complaint-in-intervention against UnitedHealth Group (UHG) in a case brought by Constantine Cannon client Ben Poehling. The government’s complaint alleges that UHG knowingly obtained inflated risk adjustment payments from Medicare Advantage based upon false information regarding the health of beneficiaries in its plans.
UHG is the nation’s largest health insurer and largest operator of Medicare Advantage plans. “As the nation’s largest Medicare Advantage Organization, UHG received substantial overpayments based upon untruthful and inaccurate information about the health status of those enrolled in its plans,” said Acting U.S. Attorney James P. Kennedy Jr. for the Western District of New York in a statement released by the Department of Justice. “Such fraudulent spending of taxpayer’s dollars will not be tolerated.”
The lawsuit was originally filed by Mr. Poehling under the qui tam provisions of the False Claims Act, which encourage whistleblowers to expose companies that are defrauding the government by allowing a private party to file a civil lawsuit on the government’s behalf and to receive a share of any recovery. “In his 2011 complaint, Mr. Poehling gave the government a road map to UHG’s risk adjustment scheme,” said Mary Inman, a partner in Constantine Cannon’s San Francisco office and co-lead counsel. “The government in its complaint today has shown it followed his map during its six year investigation to find further evidence of the same fraud.”
On Monday evening, the New York Times published a profile of Mr. Poehling, a former finance director at UHG, and his lawsuit. “You or I or the average person is probably appalled by this,” Mr. Poehling said in an interview with the reporter. “But the scheme here was not about delivering better care to members — the thing you would expect from a health care company. It was about increasing the bottom line.”
* * *If you would like more information or would like to speak to a member of Constantine Cannon’s whistleblower lawyer team, please click here.