News: Limited case against UnitedHealth Group moves forward

In May 2017, two whistleblower law suits were levied against UnitedHealth Group, accusing the group of artificially inflating Medicare Advantage patients’ risk scores by billing for diagnoses unsupported by the documentation.

A federal judge dismissed one of the cases against UnitedHealth, ruling that the Department of Justice (DOJ) failed to prove the government wouldn’t have continued making payments to UnitedHealth had it been aware of the alleged fraudulent practices in the lawsuit, according to FierceHealthcare. Since then, UnitedHealth petitioned the court to dismiss the other case as well.

Last week, U.S. District Court Judge Michael Fitzgerald agreed to dismiss some of the claims against UnitedHealth regarding the risk adjustment payments made before 2009. However, other claims were left standing, according to the ruling, including those which allege that after conducting chart reviews and finding invalid codes, UnitedHealth failed to delete invalid diagnosis codes.

 “Codes that were shown to be invalid by the Claims Verification Program were not automatically deleted, and were instead labeled ‘potential deletes,’” according to the ruling. When UnitedHealth’s budget got tighter according to the allegations, the compliance program (including the claims reviews) was terminated and UnitedHealth “chose not to delete over 100,000 invalid codes of which they had actual knowledge.”

The U.S. government has until February 26 to amend the case to only include the invalid diagnosis code allegations after 2009. According to the ruling, this will be the last amendment made to the case.

Editor’s note: To read ACDIS Director Brian Murphy’s four-part series on this case against UnitedHealth, click here.