UnitedHealthcare, one of the nation’s largest health insurers, may have improperly taken billions of dollars from Medicare by claiming for years
that people under its care were sicker than they were, according to a lawsuit made public Thursday at the Justice Department’s request.
Instead of slowing Medicare costs, UnitedHealthcare may have improperly added excess cost running into the billions
of dollars over more than a decade, according to documents unsealed in Federal District Court in Los Angeles.
The allegations were first made in 2011, when a former UnitedHealthcare executive, Benjamin Poehling, filed a complaint under the False Claims Act, a federal law
that lets private citizens take legal action when they believe a government program has been defrauded.
The accusations at issue in the suit center on Medicare Advantage, a program through which people 65 or older agree
to join private health maintenance organizations, or H. M.O.s, whose costs are reimbursed by the government.
In its own filing this week, the Justice Department asked the court to grant access to all documents produced as
Mr. Poehling’s case against the other defendants proceeds, and it reserved the right to join those cases later.
The program was created in 2003 after UnitedHealthcare and other insurers said
that managed care could help hold down the overall cost of Medicare, which has strained the federal budget by rising faster than the rate of inflation.