The U.S. Department of Justice is investigating four major insurance companies four insurance companies, alleging that they submitted false Medicare claims to increase risk adjustment payments and kept overpayments from CMS.
They include, Aetna, 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 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.
Jeffrey Newman represents whistleblowers