A federal court judge ruled against UnitedHealth's attempt to dismiss a False Claims Act suit related to overpayments, according to a report on Lexology. Here are six insights:
1. The Department of Justice alleged UnitedHealth was aware of substantial overpayments resulting from exaggerated illness levels and invalid diagnoses codes for patients enrolled in Medicare Advantage Plans from 2011 through 2014. Despite this knowledge, the DOJ claims, the insurer failed to repay more than $1 billion in overpayments from Medicare.
2. UnitedHealth argued it didn't violate the False Claims Act because the billing problems weren't "material." It backs this argument by claiming CMS continued making payments despite being on notice that some of the billing codes were incorrect.
3. U.S. District Judge Michael Fitzgerald determined the government adequately proved UnitedHealth knowingly avoided financial obligations, and the failure was material.
4. The federal judge also ruled UnitedHealth's alleged false attestations about the data's validity did not affect payment decisions by CMS.
5. UnitedHealth will likely continue challenging the DOJ's further claims.
6. The decision indicates Medicare Advantage insurers might be hit with huge penalties if they overlook questionable diagnoses and neglect to return government payments as a result, according to Law 360.