trending Market Intelligence /marketintelligence/en/news-insights/trending/FxpTK0LogpBKbuVQ6ZVBdA2 content esgSubNav
In This List

DOJ joins 2nd lawsuit claiming UnitedHealth defrauded Medicare


Anticipate the Unknown: Does Supply Chain Disruption Lead to Increased Credit Risk?


Data Stories: Data insights to help alleviate business complexity amid geopolitical risks


Expand Your Perspective: Data & Distribution Q&A


Street Talk | Episode 90: Banks should not wait on the Fed to put cash to work

DOJ joins 2nd lawsuit claiming UnitedHealth defrauded Medicare

The U.S. Department of Justice joined a second whistleblower lawsuit against UnitedHealth Group Inc. that alleges the company committed fraud with its Medicare Advantage health plans, according to court documents.

The move comes on the heels of authorities also joining a 2011 lawsuit against the healthcare giant that claimed UnitedHealth defrauded the U.S. government out of hundreds of millions of dollars with false beneficiary claims.

On March 27, the DOJ was granted a motion to consolidate the two lawsuits, particularly pertaining to pretrial and trial activities, according to a court filing.

"Litigating against Medicare Advantage plans to create new rules through the courts will not fix widely acknowledged government policy shortcomings or help Medicare Advantage members," the company said in a statement, according to the Star-Tribune. UnitedHealth did not respond to multiple inquiries for comment from S&P Global Market Intelligence.

The lawsuit was initially filed in 2009 by James Swoben in California. Swoben's case has since evolved beyond its initial target in SCAN Health Plan to include UnitedHealth. The case alleges that the company retrospectively altered medical record reviews to inflate Medicare claims.

For the full year of 2016, UnitedHealth brought in about $56.33 billion in revenue in its medicare and retirement segment.

In March, the DOJ also disclosed an investigation into four other insurers — Health Net Inc., Aetna Inc., Humana Inc. and Cigna Corp.'s Bravo Health Inc. — to determine if there was any Medicare fraud on their part as well. In a document tied to that 2011 lawsuit, the DOJ wrote that it "has been conducting, and continues to conduct, on-going investigations" of the companies.