The federal government has decided to intervene in a recent UnitedHealth Group whistleblower lawsuit by joining the whistleblower in allegations that the insurance company engaged in Medicare fraud.

This is the second UnitedHealth Group whistleblower lawsuit recently filed against the company. The first whistleblower lawsuit was unsealed in February, revealing allegations that the insurer received hundreds of millions, and possibly billions, of dollars from overpayments made by the government that were calculated based on open risk adjustment.

A filing in March of this year indicated that federal prosecutors wish to consolidate the two UnitedHealth Group cases.

The company has issued similar statements after the filing of each UnitedHealth Group whistleblower lawsuit that it was confident that it was in full compliance with Medicare rules.

In addition, the federal government said near the time of the most recent whistleblower filing that it was currently investigating risk adjustment practices of other health insurance companies, including Aetna and a particular division of Cigna.

UnitedHealth Group, parent company to the largest insurer in the nation, UnitedHealthcare, is also the largest provider of Medicare Advantage health insurance plans. Under these Medicare Advantage plans, the federal government pays the health insurance company monthly to manage the healthcare of those enrolled on a per-member per-month basis.

For patients at risk of needing more expensive treatment, Medicare increases the “capitation” payments to the insurance companies that covers healthcare costs plus overhead.

In the more recent whistleblower lawsuit, the whistleblower alleged that the insurance provider initially sent related health information to Medicare about patient diagnoses in order to receive proper payment, and subsequently went through the records again to find additional diagnoses that would allow receipt of additional payments.

Retrospective reviews like these are undertaken in order to increase the accuracy of information related to risk adjustment, the lawsuit states. However, the UnitedHealth Group whistleblower lawsuit says that UnitedHealthcare did not use the information that they gathered to correct previous errors in information that was already submitted to Medicare.

“Defendants designed, utilized and/or conducted retrospective reviews that resulted in only adding diagnosis codes that were not previously reported to the government … but concealed, and failed and refused to withdraw, diagnosis codes previously reported to the government that were unsupported by the reviewed medical charts,” the UnitedHealth Group whistleblower lawsuit states.

The whistleblower lawsuit goes on to state that if United Healthcare had gone on to correct the previous information, it “would have lowered defendants’ MA patients’ risk scores and thus lowered payments by the government to defendants.”

Whistleblower Lawsuits Offer Protection, Large Monetary Incentive Awards

When whistleblowers file a False Claims Act claim alleging that they are aware of fraud being committed against the government, they are offered protection from retaliation by their employer. Additionally, for their help in assisting in combating fraud against the government, whistleblowers are paid between 15 and 30% of the settlement or judgment amount in these cases. Incentive awards can sometimes reach into the millions of dollars.

If you have witnessed fraud against the government, you may be eligible to file a whistleblower lawsuit. These types of lawsuits are complicated, and it is important to have the advice of an experienced whistleblower attorney to guide you. It is important that you seek legal consultation and avoid reporting the misconduct to whistleblower hotlines if you are intending to proceed with a lawsuit.

For those who qualify, an experienced whistleblower attorney can review your case at no charge and can help guide you in the legal options that are available to you.