Looks like we've got some quality qui tam actions that the DOJ is joining. If proven true, this would be the second largest Medicare fraud case following the HCA systematic fraud committed in the 1990s under then-CEO Ric Scott.

Texas tie-in: UnitedHealth is the third party administrator for Texas ERS and recently testified that emergency service benefits for Texas state employees should be reduced.

Quote:

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The Justice Department sued Minnetonka, Minn.-based UnitedHealth Group Tuesday, alleging the payer defrauded Medicare at least $1 billion in false claims.

In the 79-page lawsuit filed in a Los Angeles federal court, the Justice Department alleged the payer knowingly inflated risk adjustment payments by providing the government inaccurate data about the health status of its beneficiaries. Department officials cited UnitedHealth's "one-sided" chart review process that reportedly didn't address errors elevating its revenues.

The department also alleges the payer ignored "invalid diagnoses from healthcare providers with financial incentives to furnish such diagnoses."

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http://www.beckershospitalreview.com/payer-issues/doj-sues-unitedhealth-over-1-billion-in-medicare-false-claims-again.html


This could have widespread impacts on the healthcare and insurance industry.

It is interesting that UNH dropped less than 3% on that news and that it is now back to the level before the news. Either the amount isn't very much versus what they make per quarter or nobody thinks it will become an issue.