March 17, 2017 / 7:29 PM / 4 months ago

U.S. probing insurers beyond UnitedHealth over Medicare charges

3 Min Read

March 17 (Reuters) - The U.S. Justice Department disclosed it is investigating four health insurers after a lawsuit accused them of defrauding Medicare by claiming patients were treated for conditions they either did not have or received no treatment for.

The Justice Department revealed the probe of Health Net Inc , Aetna Inc, Cigna Corp's Bravo Health Inc and Humana Inc in papers filed on Tuesday in federal court in Los Angeles in a lawsuit the government recently joined against UnitedHealth Group Inc.

The Justice Department last month partially intervened in the U.S. False Claims Act lawsuit brought by a former UnitedHealth executive, Benjamin Poehling, whose whistleblower case against the company and other insurers was filed under seal in 2011.

Under the False Claims Act, whistleblowers can sue companies on the government's behalf to recover taxpayer money paid out based on fraudulent claims.

If successful, whistleblowers receive a percentage of the recovery. A government decision to intervene is typically a major boost to such cases.

When it initially intervened in the case in February, the Justice Department said it was declining to pursue claims against other insurers named in the lawsuit besides UnitedHealth.

But on Tuesday, the Justice Department filed a "corrected notice" of intervention, saying that, due to ongoing investigations of Health Net, Aetna, Bravo and Humana, it could not make a decision as to whether to proceed against them.

Representatives for Health Net, Aetna, Cigna and Humana did not immediately respond to a request for comment on Friday, nor did the Justice Department. A lawyer for Poehling had no immediate comment.

Poehling's lawsuit accused UnitedHealth, Health Net, Aetna, Bravo Health, Humana and other insurers of defrauding the United States of hundreds of millions - and likely billions - of dollars through claims for payments from the Medicare healthcare program for the elderly.

The lawsuit centered on "risk adjustment" payments that Medicare makes to managed-care plans to offset the increased costs associated with treating patients with multiple or serious health conditions.

The lawsuit claimed that, in seeking those payments, the insurers falsely claimed that patients were treated for diagnoses they did not have or were not treated for.

UnitedHealth has said it rejects the lawsuit's allegations and would contest them in court. A spokesman had no immediate comment on Friday.

The case is U.S. ex rel. Benjamin Poehling v. UnitedHealth Group Inc et al, U.S. District Court, Central District of California, No. 16-cv-08697. (Reporting by Nate Raymond in Boston; Editing by Anthony Lin and Jonathan Oatis)

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