DOJ investigates 4 insurers following accusations of Medicare fraud

The U.S. Department of Justice will investigate four insurers after a lawsuit alleged they submitted false Medicare claims to increase risk adjustment payments and kept overpayments from CMS, according to a Reuters report.

The investigation includes Hartford, Conn.-based Aetna, Bloomfield, Conn.-based Cigna subsidiary Bravo Health, Woodland Hills, Calif.-based Health Net and Louisville, Ky.-based Humana, according to papers filed last week in a Los Angeles federal court. The insurers were included in the same lawsuit the DOJ joined last month concerning Minnetonka, Minn.-based UnitedHealth Group and its subsidiary WellMed Medical Management. The lawsuit alleged the payers used incorrect coding to increase Medicare Advantage risk scores.

The allegations were originally presented by Benjamin Poehling, former finance director of UnitedHealthcare Medicare and Retirement. Mr. Poehling filed the U.S. False Claims Act lawsuit under seal in 2011 against 15 companies. He accused the payers of defrauding "hundreds of millions — and likely billions — of dollars," from Medicare, the lawsuit states.

UnitedHealth has said it would contest the lawsuit. Humana spokesperson Tom Noland told Reuters the payer would work with authorities and that it has already reported the investigation with the Securities and Exchange Commission. 

Cigna did not respond to Reuters request for comment, and Aetna and Heath Net declined comment to the publication.  

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