The U.S. Department of Justice joined San Francisco-based Constantine Cannon's whistleblower lawsuit against Hopkins, Minn.-based UnitedHealth Group, saying the payer allegedly overcharged Medicare by several hundreds of millions of dollars.
Here's what you should know.
1. The suit alleges UnitedHealth overcharged CMS through its risk-adjustment scores. The payer submitted claims to CMS for conditions beneficiaries either didn't have or were not treated for, according to the suit.
2. A Los Angeles federal court unsealed the complaint Feb. 16, 2017.
3. UnitedHealth allegedly targeted Part C and Part D programs.
4. Under Medicare rules, the payer should've reported and reimbursed the government for any over payments.
5. The complaint alleges UnitedHealth found high error rates in its claims, but "refused to take meaningful, widespread steps to identify and rectify the problems with the claims."
6. UnitedHealth spokesman Matthew Burns said, "[UnitedHealth] rejects these more than five-year-old claims and will contest them vigorously. We are honored to serve millions of seniors through Medicare Advantage, proud of the access to quality health care we provided, and confident we complied with the program rules."