In The News

California Whistleblower is joined by the Government in a Lawsuit Against UnitedHealth Group

The Department of Justice announced earlier this month that the government has joined a lawsuit that has been filed against UnitedHealth Group (UHG) by a whistleblower. The government formally filed papers to intervene in the suit in late March of this year. The suit was originally filed by whistleblower James Swoben in 2009. Swoben has accused the company of taking advantage of the Medicare Advantage payment system by misrepresenting the health status of its patients. This was done by UHG, Swoben alleges, in an effort to boost payment rates from the federal Medicare program. Furthermore, Swoben has alleged that he has proof that UHG has been involved in fraudulent activities that could have cost the government more than $1 billion.


For its part UHG denies any wrongdoing. “We are honored to serve millions of seniors through Medicare Advantage, proud of the access to quality healthcare we provided, and confident we complied with program rules,” said UnitedHealth spokesman Matt Burns. On the other hand, the case in which the government has intervened involves government payments that Swoben and the Justice Department maintain, “gamed” the rules for “risk adjustment.” Under these rules, government payments are adjusted upward for insurers who cover patients with costlier health conditions. The government alleges that UHG boosted adjustment claims by submitting forms for conditions that health plan members did not have.


Medicare Advantage – which serves as an alternative to Medicare – is used by more than 18 million disabled and elderly Americans and cost nearly $150 billion a year to maintain. In the past, nearly half a dozen whistleblower Medicare lawsuits have been filed against companies that are alleged to have over-billed or otherwise committed fraud against the popular program. “This is not one company engaged in episodic bad behavior, but a lucrative business plan that appears to be national in scope,” said Patrick Burns associate director of Taxpayers Against Fraud in Washington. The group is a nonprofit profit organization supported by whistleblowers and their lawyers.


The government is also attempting to combine the Swoben case with another whistleblower action filed in 2011 by former UnitedHealth executive Benjamin Poehling. Poehling alleged then that UHG generated hundreds of millions in overpayments. If you have chosen to disclose False Claims Act violations to the government it is also advised that you contact a whistleblower law firm. A whistleblower attorney can advise you in such matters and will work to protect your rights under the law.