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Tuesday, April 22, 2025

Report finds ‘complete failure’ of evidence against UnitedHealth Group in whistleblower case - Star Tribune

A court-appointed special master says the Justice Department hasn’t developed “any evidence” for key claims. Her recommendation now goes to a federal judge.

The Minnesota Star Tribune

A court-appointed special master is recommending a 14-year-old whistleblower lawsuit not be allowed to move forward after finding no evidence to support key allegations that UnitedHealth Group wrongly collected billions of dollars by gaming risk-adjustment payments in the Medicare Advantage program.

The case, which the Justice Department joined in 2017, alleged the Eden Prairie-based health care giant engaged in one-sided reviews of medical charts to find evidence supporting higher payments for the company, but didn’t use the information to correct “unsupported” billing codes for which UnitedHealth Group also collected fees.

The case in the U.S. District Court for the Central District of California was originally filed in March 2011 under seal by Benjamin Poehling, a former director of finance who started working for UnitedHealth Group in Minnesota in 2004.

In a report issued Monday, the special master found the government lacked “any evidence” to support key elements of its case.

“The government needed to present evidence from which a jury could reasonably conclude that the diagnosis codes United submitted were invalid, i.e., that codes were not supported by the related medical record,” wrote Special Master Suzanne Segal. “The complete failure of any evidence on this essential element must...



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