UnitedHealth's Medicare business draws federal scrutiny

Allegations that Twin Cities-based UnitedHealth Group massively overcharged Medicare for services have drawn the attention of the United States Justice Department, but UnitedHealth, the nation's largest health insurer, says it has done nothing wrong.

The Justice Department is joining a whistleblower lawsuit filed about five years ago by Benjamin Poehling, a former UnitedHealth executive who served as director of finance for UnitedHealthcare Medicare & Retirement, a UnitedHealth Group unit. Poehling contends that more than a dozen insurers, including UnitedHealth and Medica, have ripped off Medicare to the tune of hundreds of millions, if not billions, of dollars.

"In submitting claims to Medicare UnitedHealth group and the other insurers either claimed that their members had diseases that they didn't have or if they did have them claims that they weren't treated for them when they were treated for them," said Tim McCormack, an attorney who represents Poehling.

The case had been under seal but became public when the Justice Department decided to get involved, although apparently only in regard to UnitedHealth and one of the insurer's subsidiaries at this point.

The lawsuit had been kept under seal to allow the feds to investigate, McCormack said, adding he expects the government will soon file its own lawsuit.

"They will file at some point the next 90 days their own complaint with a lot more information than is currently in our complaint," he said. "And we will work with them. We will support the government. It's a way for the government and private sector to team up and work together."

The government gets involved in relatively few such cases, but the odds of prevailing grow with the addition of the government's power to investigate.

Whistleblowers can be well-rewarded for calling attention to wrongdoing. If the government recovers money, the whistleblower gets a share, perhaps 20 percent or more.

For its part, UnitedHealth categorically disputes Poehling's allegations.

"We reject these more than five-year-old claims and will contest them vigorously," said company spokesperson Matthew A. Burns. "We're honored to serve millions of seniors through Medicare Advantage, proud of the access to quality health care we provided, and confident that we complied with the Medicare Advantage program rules."

Although Minnetonka-based Medica was named in Poehling's lawsuit, the feds have not signaled they're going after the nonprofit insurer.

Your support matters.

You make MPR News possible. Individual donations are behind the clarity in coverage from our reporters across the state, stories that connect us, and conversations that provide perspectives. Help ensure MPR remains a resource that brings Minnesotans together.