The U.S. Department of Justice is pushing forward with a whistleblower lawsuit against UnitedHealth Group, despite a special master’s report in March backing the company by finding the case suffered from a “complete failure” of evidence.
Over a period of several years, the Eden Prairie-based health care giant asked its medical coders to scour records and find missing diagnosis codes — a process that generated $7.2 billion in additional payments to the company’s Medicare Advantage health plans, which are paid extra to cover sicker patients, according to a Wednesday court filing by Justice Department prosecutors.
Yet when those same coders found medical records that did not support 1.97 million previously submitted medical codes, the company did not report that information to the government, and ultimately kept $2.1 billion to which UnitedHealth was not entitled, the Justice Department’s new filing says.
“The Special Master’s Report and Recommendation blesses that conduct ... [and] is fundamentally flawed,” according to the memorandum filed with the U.S. District Court for the Central District of California.
Wednesday’s filing is the latest volley in a whistleblower case that originally was filed under seal in March 2011 by Benjamin Poehling, a former director of finance who started working for UnitedHealth Group in Minnesota in 2004. The Justice Department later joined the case as plaintiff against UnitedHealth.
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