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Risk Adjustment Fraud

This archive displays posts tagged as relevant to risk adjustment fraud in managed care programs You may also be interested in our pages:

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February Roundup – February 17-20, 2017

Constantine Cannon attorneys quoted in articles about the DOJ joining its whistleblower lawsuit against UnitedHealth Group:
  • UnitedHealth Filing Reflects DOJ’s Heightened Fraud Focus, Bloomberg BNA;
  • Whistleblower suit alleges UnitedHealth defrauded Medicare, StarTribune;
  • Justice Department joins Medicare Advantage fraud lawsuit against UnitedHealth, Modern Healthcare;
  • Feds Join FCA Suit Targeting UnitedHealth Billing, Law360;
  • United Healthcare Whistleblower Suit Provides ‘Interesting’ Investment Opportunity, The Street;
  • Lawsuit says UnitedHealth tied to scheme to overbill Medicare, MINNPOST;
  • DOJ joins whistle-blower suit accusing UnitedHealth of overbilling Medicare , Becker's Hospital Review;
  • Justice Department joins lawsuit against UnitedHealth over Medicare billing, Minneapolis/St. Paul Business Journal;
  • UnitedHealth Lower Off NYT Article Claiming Suit For Overbilling Medicare, Benzinga;
  • UnitedHealth, Health Insurers Fall As DOJ Joins Whistleblower Suit, Investor's Business Daily;
  • Feds join whistleblower suit that accuses UnitedHealth of inflating Medicare Advantage risk scores, Fierce Healthcare;
  • United Health sinks after being sued by the US government (UNH), Business Insider;
  • Feds join whistleblower lawsuit claiming UnitedHealth overcharged Medicare, TwinCities (Pioneer Press);
  • UnitedHealth leads Dow losses after US joins whistleblower case, Financial Times;
  • UnitedHealth shares fall after Justice Department joins Medicare whistleblower lawsuit, CNBC ;
  •  UnitedHealth's Medicare business draws federal scrutiny, Minnesota Public Radio;
  • DOJ joins whistleblower lawsuit against UnitedHealth Group, WellMed, Healthcare Finance News;
  • Suit Says, Scheme Tied to UnitedHealth Overbilled Medicare for Years, Morning Outlook; and
  • UnitedHealth Group Targeted by Whistleblower Lawsuit, Hamodia.

UnitedHealth Group, Inc. – Medicare Advantage Risk Adjustment Fraud (Case Intervention)

Constantine Cannon represents the whistleblower in one of the largest Medicare Advantage risk adjustment cases in history.  Our client, Benjamin Poehling, alleges that UHG, the nation’s largest health insurer, together with its related Medicare Advantage Organizations, knowingly inflated Medicare Advantage risk scores by engaging in “one-way” chart reviews, even after he expressed concern about this practice to fellow executives.  The United States filed a complaint in intervention in May, 2017, and the case continues to be actively litigated, with trial scheduled in late 2021. See: Government Complaint in Intervention; Poehling Second Amended Complaint; Constantine Cannon Press Release.

United States Intervenes in Constantine Cannon Whistleblower’s suit against UnitedHealth Group, WellMed Medical Management

Posted  02/16/17
By the C|C Whistleblower Lawyer Team The U.S. Department of Justice has joined Constantine Cannon in bringing a whistleblower’s False Claims Act lawsuit against UnitedHealth Group, the nation’s largest health insurer and largest operator of Medicare managed healthcare insurance plans. The suit alleges UnitedHealth and its various subsidiaries and affiliates defrauded Medicare by improperly inflating its risk...

Medicare Advantage Plan Loses Members, Responds with Plans to Raise Risk Adjustment Scores

Posted  09/21/15
The Compliance & Ethics Blog (September 21, 2015) Click here to read the article.

Medicare Part C: Fighting Back Against Risk Adjustment Fraud

Posted  06/26/15
Health insurance companies that participate in the Medicare Managed Care program (also known as Medicare Advantage or Medicare “Part C”) routinely complain about cuts to their reimbursement rates – even in years, like this one, where the reimbursement rates are actually increased.  At the same time, reports indicate that insurers are “leaning heavily on their Medicare business” and “signal[ing their]...

Beyond RADV: Does Your Plan's Risk Adjustment Strategy Run Afoul of the False Claims Act

Posted  02/13/12
CC Attorney Mary Inman
Presented at the HCCA Managed Care Compliance Conference (February 13, 2012).  Click here to view the presentation.
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