DOJ drops Medicare Advantage fraud suit against UnitedHealth

The U.S. Department of Justice (DOJ) has abandoned a lawsuit against UnitedHealth over allegations the insurer submitted false claims in its Medicare Advantage plans, though a similar case remains active.

This case, brought by former SCAN Health Plan data manager James Swoben, was dismissed by Judge John Walter in the U.S. District Court for Central California. Walter ruled federal prosecutors failed to show UnitedHealth executive may have knowingly submitted false claims to CMS about its risk adjustment data, as the lawsuit alleged.

"The complaint … fails to identify the corporate officers who signed the attestations or allege that those individuals knew or should have known that the attestations were false," he wrote.

The ruling did leave the door open for the DOJ to refile its case, but the agency elected not to do so.

“We are pleased with the government’s decision to dismiss these meritless claims,” UnitedHealth spokesman Matt Burns in a statement to Reuters.

That’s not the end of similar allegations against the insurer’s Medicare Advantage business. A separate lawsuit filed by former UnitedHealth executive Benjamin Poehling which the DOJ had also joined is still pending. Poehling has claimed he monitored data-mining projects to find conditions to increase payments to UnitedHealth, calling it a “perfect scheme” that may have netted more than $1 billion for the company since 2005.