DOJ joins lawsuit against largest health insurer for defrauding Medicare program News
DOJ joins lawsuit against largest health insurer for defrauding Medicare program

The US Department of Justice (DOJ) [official website] joined [press release, PDF] a whistleblower lawsuit [complaint, PDF] on Thursday against UnitedHealth Group [corporate website]. The suit claims that the country’s largest health insurer, and its affiliates, were overcharging the Medicare program millions of dollars. The suit also alleges that UnitedHealth Group was defrauding Medicare by claiming that their insurance members were treated for conditions they never were. Defendants are accused of violating the False Claims Act [text] using these risk adjustment [text] tactics. The lawsuit was originally filed in 2011 but was sealed while the DOJ completed its investigations. The DOJ now claims to have enough evidence against WellMed Medical Management [corporate website], a company acquired by UnitedHealth Group in 2011.

Healthcare has continuously been an issue in the US. In January a district court judge prohibited [JURIST report] the merger of two major health insurance companies, affirming the DOJ decision that the merger would inhibit competition and hurt consumers. In June California Governor Jerry Brown [official website] signed a bill [JURIST report] into law to allow undocumented immigrants to purchase healthcare plans. In November the US Supreme Court granted certiorari [JURIST report] to determine if healthcare companies are precluded from recouping reimbursements under the Federal Employee Health Benefits Act.