By Erica Teichert | February 27,
2018
The U.S. Justice Department on Monday ditched most of its lawsuit
over UnitedHealth Group's Medicare Advantage billing practices.
In a brief notice to a federal district court in Los Angeles, the Justice Department said it wouldn't update its lawsuit to revive claims over the accuracy of UnitedHealth's Medicare Advantage billing data. Instead, the federal government will only litigate whether the data used to secure more than $1 billion in Medicare Advantage payments was invalid.
U.S. District Judge Michael Fitzgerald pared down the suit earlier in February, determining that any statements UnitedHealth made about the data's accuracy wouldn't have affected whether the government paid the Medicare Advantage claims.
UnitedHealth's vice president of communications Matt Burns said the company will "continue to contest aggressively the remaining claims."
Medicare Advantage plans are paid a flat per-beneficiary fee from the CMS for covering individuals. The agency adjusts payments to take into account sicker members by using risk scores. There have been several whistle-blower lawsuits in recent years alleging health plans inflate members' risk scores to secure higher payments.
UnitedHealth, Aetna, Health Net, Humana and Cigna's Bravo Health are all under federal scrutiny for potential upcoding issues.
The federal government has seen both of its False Claims Act suits over UnitedHealth's Medicare Advantage billing fall flat in the last several months. In October, the Justice Department dropped a similar lawsuit alleging UnitedHealth and its affiliated plans exaggerated how sick its patients were to score millions of dollars in inflated Medicare Advantage payments.
In a brief notice to a federal district court in Los Angeles, the Justice Department said it wouldn't update its lawsuit to revive claims over the accuracy of UnitedHealth's Medicare Advantage billing data. Instead, the federal government will only litigate whether the data used to secure more than $1 billion in Medicare Advantage payments was invalid.
U.S. District Judge Michael Fitzgerald pared down the suit earlier in February, determining that any statements UnitedHealth made about the data's accuracy wouldn't have affected whether the government paid the Medicare Advantage claims.
UnitedHealth's vice president of communications Matt Burns said the company will "continue to contest aggressively the remaining claims."
Medicare Advantage plans are paid a flat per-beneficiary fee from the CMS for covering individuals. The agency adjusts payments to take into account sicker members by using risk scores. There have been several whistle-blower lawsuits in recent years alleging health plans inflate members' risk scores to secure higher payments.
UnitedHealth, Aetna, Health Net, Humana and Cigna's Bravo Health are all under federal scrutiny for potential upcoding issues.
The federal government has seen both of its False Claims Act suits over UnitedHealth's Medicare Advantage billing fall flat in the last several months. In October, the Justice Department dropped a similar lawsuit alleging UnitedHealth and its affiliated plans exaggerated how sick its patients were to score millions of dollars in inflated Medicare Advantage payments.
Erica Teichert assigns, edits and directs news
coverage for Modern Healthcare’s website and magazine. She previously served as
the publication’s New York bureau chief and legal reporter. Before joining
Modern Healthcare in 2016, she worked at Law360 as legal newswire’s first D.C.
bureau chief after three years as a court reporter covering the U.S. Supreme
Court, D.C. Circuit and other federal courts and agencies. Prior to that, she
worked as an associate editor for FierceMarkets. She has a bachelor's degree in
communications with a print journalism emphasis from Brigham Young University.
No comments:
Post a Comment