With all of the news surrounding the fate of the Affordable Care Act lately, you may have missed that the government intervened in two lawsuits alleging fraud against the country’s largest health insurance company, Minnetonka-based UnitedHealth Group. Since the beginning of this year, the Department of Justice joined two separate False Claims Act cases against UnitedHealth. Both qui tam lawsuits (the Latin phrase commonly used for False Claims Act cases brought by a whistleblower) allege that UnitedHealth fraudulently inflated its Medicare Advantage risk adjustment scores.
So, what is the Medicare Advantage program? What are risk adjustment scores? And how can a major health insurance company, like UnitedHealth, defraud the government? The answers to each of these questions can be found in this post.