When Medicare was facing an impossible $13 trillion funding gap, Congress opted for a bold fix: It handed over part of the program to insurance companies, expecting them to provide better care at a lower cost. The new program was named Medicare Advantage.
Nearly 15 years later, a third of all Americans who receive some form of Medicare have chosen the insurer-provided version, which, by most accounts, has been a success.
But now a whistle-blower, a former well-placed official at UnitedHealth Group, asserts that the big insurance companies have been systematically bilking Medicare Advantage for years, reaping billions of taxpayer dollars from the program by gaming the payment system.
U.S. Sues UnitedHealth Over Medicare Charges
The Justice Department has sued UnitedHealth Group, saying that senior executives knew the company was overbilling Medicare by hundreds of millions of dollars a year, and halted a repayment plan in 2014 so the money could be used to meet Wall Street’s revenue expectations.
In a complaint filed Tuesday in United States District Court in Los Angeles, the Justice Department said UnitedHealth routinely combed through millions of patients’ medical charts, searching for data it could use to make patients look sicker than they really were, in what the lawsuit called “strictly a one-sided revenue generating program.”
Under the government’s popular old-age health program, Medicare Advantage, reporting unhealthier customers led to bigger payments from the federal government — $3 billion worth to UnitedHealth from 2010 to 2015 alone, according to the complaint. The Justice Department said misrepresenting people’s health was a civil fraud and sued for triple damages and other penalties.
