When someone blows the whistle on a company, the United States government has a right to step in and move forward with the case. In a recent lawsuit against UnitedHealth Group (UHG), the government has decided to do just that.
The lawsuit, reported on May 2, states that the company obtained larger-than-necessary risk-adjustment payments due to inaccurate information about the statuses of beneficiaries in UHC or California, the UHG's largest Medicare Advantage Plan. If this proves to be true, it would mean that the company provided false information to the government to obtain higher compensation rates.
The company is also part of a related lawsuit that states that it defrauded the Medicare Program directly. The company, which has over 50 Medicare Advantage and Drug Prescription plans, provides this care to millions of people around the United States. The company receives a payment each month for each beneficiary. Those payments are based on the health of the patients. The company is alleged to have ignored and failed to report incorrect diagnoses, which raised the amount it was paid by the government.
This particular lawsuit was filed by a former employee of the Senior Care Action Network Health Plan. He sued on behalf of the government through the qui tam provisions of the False Claims Act. The United States government is expected to move forward in the case by the middle of May.
This is just one example of how a single person can help combat fraud in the government. If you know that your company is defrauding the government, you can come forward through the False Claims Act and file a claim.
Source: Street Insider, "UPDATE: U.S. Intervenes in False Claims Act Suit Against UnitedHealth Group (UNH)," May 02, 2017