The lawsuit claims the insurance provider submitted invalid data concerning the health status of patients enrolled in Medicare Advantage plans to the tune of more than $1 billion.
Medicare helps about 56 million people of which approximately 19 million have chosen to enroll in Medicare Advantage plans as an alternative to a standard plan. United Healthcare is the nation’s biggest insurer of Medicare Advantage clients, covering about 3.6 million people in 2016 alone.
Benjamin Poehling, a whistleblower who initiated a lawsuit against UnitedHealth in 2011 after serving as the insurer’s finance director, said his former employer had instigated the “perfect scheme” to game Medicare. The risk adjustment scheme UnitedHealth came up with, Poehling explained, was designed for the sole purpose of increasing the company’s profit margin. “I came to the point where I couldn’t participate in what they were asking me to do anymore,” he said.
Asked for comment, United Healthcare spokesman Matt Burns said, simply “We reject them.” Representatives say it will continue contesting the Justice Department’s outstanding allegations.
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