by
Thomas Dworetzky, Contributing Reporter | May 03, 2017
UnitedHealth is the largest Medicare Advantage group in the U.S.
The suit claims that the insurer paid for chart reviews by HealthCare Partners to see if it could boost risk-adjusted payments for patients being cared for by that group. At issue is a claim that the insurer “allegedly ignored information from these chart reviews about invalid diagnoses, and thus avoided repaying Medicare monies to which it was not entitled,”
according to Pasadena News Now.
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These reviews "identified information leading to increased government payments ... while systematically ignoring information that would have led to decreased payments," the lawsuit stated. "By failing to 'look both ways,' UnitedHealth improperly generated and reported skewed data artificially inflating beneficiaries' risk scores, avoided negative payment adjustments and retained payments to which it was not entitled," according to the StarTribune.
“The intervention of the United States in this matter illustrates our commitment to ensure the integrity of the Medicare Part C program,” said Acting Assistant Attorney General Chad A. Readler of the Justice Department’s Civil Division.
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