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U.S. drops lawsuit against UnitedHealth after losing court ruling

Reuters 

By Brendan Pierson

(Reuters) - The U.S. dropped a accusing Group Inc of submitting false claims to get inflated Medicare payouts, a filing on Thursday showed, a week after a judge dismissed the complaint but said it could be amended.

U.S. John Walter in Los Angeles ruled that the failed to identify any officers who signed documents vouching for data submitted to the Medicare Advantage programme, or to claim that any of them knew they were signing off on false information.

"We are pleased with the government's decision to dismiss these meritless claims," said spokesman Matt Burns in a statement.

The U.S. Department of Justice, which filed the lawsuit, declined to comment. A second by the government, accusing of obtaining over $1 billion of Medicare payouts it was not entitled to, remains pending.

Medicare Advantage, an alternative to the standard fee-for-service Medicare in which private insurers manage health benefits, is the fastest growing form of health insurance, with enrolment of 18 million people last year.

The dismissed said that since at least 2005, knew many of the diagnosis codes it submitted to the Medicare programme for increased payments, based on "risk" factors like health status, were not supported by patients' medical records.

But the company turned a blind eye, the said, funding and encouraging one-sided chart reviews of patients of HealthCare Partners, which provided services to beneficiaries in California.

As a result, was able to wrongfully retain risk adjustment payments it received from the government, the said.

The Department of Justice filed the in May after it partially intervened in a whistleblower brought by James Swoben, a former employee of Senior Care Action Network Health Plan and a consultant to the risk adjustment industry.

The case is U.S. ex rel Swoben v. Scan Health Plan et al, U.S. District Court, Central District of California, No. 09-cv-05013.

(Reporting by Brendan Pierson in New York; Editing by Richard Chang)

(This story has not been edited by Business Standard staff and is auto-generated from a syndicated feed.)

First Published: Sat, October 14 2017. 00:20 IST
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