NPR and Kaiser Health News report that the Justice Department has joined a California whistleblower’s lawsuit accusing UnitedHealth Group of fraud in its popular Medicare Advantage health plans.
Whistleblower James Swoben says UnitedHealth is “gaming” the Medicare Advantage payment system by “making patients look sicker than they are”. He says the combined cases could prove to be among the largest fraud cases against Medicare, with damages that he says could top $1 billion.
UnitedHealth denies any wrongdoing. Spokesman Matt Burns saying “We are honored to serve millions of seniors through Medicare Advantage, proud of the access to quality healthcare we provided, and confident we complied with program rules.”
According to the Medicare Fraud Center the most common types of fraud include:
The Centers for Medicare and Medicaid Services (CMS) estimated in a past report that more than $60 billion of American taxpayer money, or more than 10 percent of Medicare’s total budget, was lost to fraud, waste, abuse and improper payments during a one year period.
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