The largest Medicare Advantage (MA) insurer, UnitedHealth, allegedly concealed hundreds of complaints about fraud and misconduct among its MA sales staff from the federal government to receive payments to which it wasn’t entitled, according to a newly unsealed whistleblower lawsuit.
UnitedHealth has been facing numerous lawsuits over MA fraud allegations. This particular complaint was filed by UnitedHealth sales agents in Wisconsin in October. As summarized by Kaiser Health News, the agents allege the insurer kept a “dual set of books” to hide complaints about its MA services and being “intentionally ineffective” when investigating its sales staff. Examples included a sales agent allegedly forged signatures on enrollment forms and another offering iPads to customers who agreed to sign up and stay in the MA plan for six months.
Concealing those complaints helped boost its bonuses from CMS for high-quality ratings, which according to the suit totaled $1.4 billion in payments in fiscal year 2016, almost triple the amount from the year before.
As with past allegations, UnitedHealth has denied any wrongdoing. Read the full article below:
John joined TriMed in 2016, focusing on healthcare policy and regulation. After graduating from Columbia College Chicago, he worked at FM News Chicago and Rivet News Radio, and worked on the state government and politics beat for the Illinois Radio Network. Outside of work, you may find him adding to his never-ending graphic novel collection.