October 17, 2017

DOJ drops lawsuit that alleged UnitedHealth inflated patient risk scores

Daily Briefing

The Department of Justice (DOJ) in a court filing Thursday dropped a lawsuit alleging that UnitedHealth Group inflated patient risk scores to improperly receive higher reimbursements from Medicare Advantage (MA).

Lawsuit details

DOJ in March joined the whistleblower lawsuit against UnitedHealth alleging that the insurer had inflated patient risk scores for UnitedHealth enrollees in California.

UnitedHealth in July had requested the case be dismissed, arguing that DOJ "fail[ed] properly to plead two elemental aspects of its claims:

  • That United knowingly submitted false attestations; and
  • That the government would have refused to pay United's claims if it had know[n] of the truth."

UnitedHealth argued, "Those failings are not careless errors," adding, "Rather, they reflect the broader problem with the DOJ's case, which is that it has attempted to turn a well-known, good-faith disagreement about the meaning of regulatory and statutory language into a False Claims Act suit."

A federal judge on Oct. 5 dismissed the lawsuit, ruling DOJ's allegations were too vague for the case to move forward. The federal judge gave DOJ until Oct. 13 to amend the lawsuit to further support the claims related to alleged misconduct occurring after May 1, 2007.

DOJ drops lawsuit

However, rather than amend the case, DOJ opted to drop the lawsuit. DOJ declined to comment on its decision, according to Reuters.

Matt Burns, a UnitedHealth spokesperson, said, "We are pleased with the government's decision to dismiss these meritless claims."

A separate lawsuit DOJ filed against UnitedHealth in May involving similar allegations is pending, according to Reuters (Pierson, Reuters, 10/13; Teichert, Modern Healthcare, 10/16).  

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