U.S. District Judge John Walter in Los Angeles ruled Thursday the DOJ’s lawsuit failed to name corporate officials of the Minnetonka, Minn.-based insurer who signed documents confirming the accuracy of information submitted to the government. Judge Walter also ruled the lawsuit did not allege any individuals knew the information was inaccurate, and the claims were material in a “conclusory” manner. In other words, the lawsuit failed to show the government would not have paid UnitedHealth if federal officials knew about the inaccuracies.
Earlier this year, the DOJ intervened in two whistle-blower lawsuits against UnitedHealth over Medicare Advantage reimbursement under the False Claims Act. The lawsuit Judge Walter rejected Thursday, which the DOJ filed in May, concerned a whistle-blower lawsuit filed in 2009 by James Swoben, a former employee of a California-based managed care plan. Mr. Swoben’s lawsuit claimed UnitedHealth purposefully submitted incorrect health status data to Medicare since at least 2005 to inflate payments.
While Judge Walter tossed the DOJ’s case, he said the department could amend its claims to address shortcomings cited in his ruling. The DOJ has until Oct. 13 to modify its lawsuit.
UnitedHealth and the DOJ declined Reuters‘ request for comment.
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