UnitedHealth Faces U.S. Suit Claiming Medicare Overpayments
- U.S. joins whistle-blower lawsuit claiming false risk scores
- Insurer sues to block U.S. rule on Medicare Advantage rule
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UnitedHealth Group Inc. was sued by the Trump Administration, which claims the insurer’s California Medicare program made false or fraudulent claims for payments after failing to adjust for the health risk of patients enrolled in its plan.
The Justice Department said Tuesday that it joined an eight-year-old whistle-blower lawsuit filed under the False Claims Act that focused on payments made to the company for its Medicare Advantage Plan. Medicare Advantage organizations, like the one UnitedHealth runs in California, receive fixed monthly payments for each enrollee. Those payments are based, in part, on patient-risk scores that weigh their medical conditions in the previous year.