Whistleblowers: United Healthcare Hid Complaints About Medicare Advantage
By Fred Schulte
Kaiser Health News
July 28, 2017
United Healthcare Services Inc., which runs the nation’s largest private Medicare Advantage insurance plan, concealed hundreds of complaints of enrollment fraud and other misconduct from federal officials as part of a scheme to collect bonus payments it didn’t deserve, a newly unsealed whistleblower lawsuit alleges.
The suit, filed by United Healthcare sales agents in Wisconsin, accuses the giant insurer of keeping a “dual set of books” to hide serious complaints about its services and of being “intentionally ineffective” at investigating misconduct by its sales staff. A federal judge unsealed the lawsuit, first filed in October 2016, on Tuesday.
The company knew of accusations that at least one sales agent forged signatures on enrollment forms and had been the subject of dozens of other misconduct complaints, according to the suit. In another case, a sales agent allegedly engaged in a “brazen kickback scheme” in which she promised iPads to people who agreed to sign up and stay with the health plan for six months, according to the suit.
Though it fired the female sales agent, United Healthcare concluded the kickback allegations against her were “inconclusive” and did not report the incident to the Centers for Medicare & Medicaid Services, according to the suit.
Asked for comment on the allegations in the suit, United Healthcare spokesman Matt Burns said: “We reject them.”...
Use Our Content
This KHN story can be republished for free (details).
Showing posts with label medicare fraud by insurers. Show all posts
Showing posts with label medicare fraud by insurers. Show all posts
Friday, July 28, 2017
Wednesday, November 2, 2011
Kaiser Foundation Health Plan Inc. penalized $1.9 million for improper Medicare claims
Kaiser penalized $1.9 million
Pacific Business News
April 15, 2005
The U.S. and state attorneys general have penalized Kaiser Foundation Health Plan Inc., Kaiser Foundation Hospitals and the Hawaii Permanente Medical Group $1.9 million for making improper Medicare and Medicaid claims.
Kaiser was penalized $1 million for submitting false federal Medicare claims and $900,000 for improper state Medicaid claims.
A Kaiser employee claimed that an employee in the dermatology department had treated patients without a required state license between May 1984 and December 2001, which was confirmed by the Medicaid Fraud Control Unit, state Attorney General Mark Bennett announced Thursday.
The state said the employee who provided the treatment wasn't a licensed physician's assistant although Kaiser billed the state Medicaid program for the services provided.
The state also found that Kaiser failed to properly supervise the treatments, although the investigation didn't reveal any evidence of improper care, substandard treatment or injury to Kaiser patients.
"We take regulatory compliance very seriously at Kaiser Permanente and we regret the mistake," said Jan Head, Kaiser president.
Kaiser says the inaccurate billings to Medicare and Medicaid occurred after the state created a certification requirement for physician assistants and that the dermatology assistant practiced at Kaiser prior to the change and failed to obtain a license after the requirement went into effect.
The whistle-blowing employee filed suit in federal court under the federal and state false claims act and will receive $225,000 of the $900,000 for informing the state.
The Medicaid program will receive $115,379 for claims made based on service provided by the unlicensed service provider and the Medicaid Investigations Recovery Fund will receive $559,621 that will be used to pay for future investigations.
Pacific Business News
April 15, 2005
The U.S. and state attorneys general have penalized Kaiser Foundation Health Plan Inc., Kaiser Foundation Hospitals and the Hawaii Permanente Medical Group $1.9 million for making improper Medicare and Medicaid claims.
Kaiser was penalized $1 million for submitting false federal Medicare claims and $900,000 for improper state Medicaid claims.
A Kaiser employee claimed that an employee in the dermatology department had treated patients without a required state license between May 1984 and December 2001, which was confirmed by the Medicaid Fraud Control Unit, state Attorney General Mark Bennett announced Thursday.
The state said the employee who provided the treatment wasn't a licensed physician's assistant although Kaiser billed the state Medicaid program for the services provided.
The state also found that Kaiser failed to properly supervise the treatments, although the investigation didn't reveal any evidence of improper care, substandard treatment or injury to Kaiser patients.
"We take regulatory compliance very seriously at Kaiser Permanente and we regret the mistake," said Jan Head, Kaiser president.
Kaiser says the inaccurate billings to Medicare and Medicaid occurred after the state created a certification requirement for physician assistants and that the dermatology assistant practiced at Kaiser prior to the change and failed to obtain a license after the requirement went into effect.
The whistle-blowing employee filed suit in federal court under the federal and state false claims act and will receive $225,000 of the $900,000 for informing the state.
The Medicaid program will receive $115,379 for claims made based on service provided by the unlicensed service provider and the Medicaid Investigations Recovery Fund will receive $559,621 that will be used to pay for future investigations.
Thursday, August 14, 2008
Patrick Fitzgerald wins in medicare fraud case against Amerigroup
2-Amerigroup to pay $225 mln Medicaid settlement
Aug 14, 2008
WASHINGTON, Aug 14 (Reuters) - Health insurer Amerigroup Corp (AGP.N: Quote, Profile, Research, Stock Buzz) will pay $225 million to settle federal and state claims of fraud in a government health insurance program, the company and the U.S. Justice Department said on Thursday.
The pact, in coordination with Illinois officials, settles allegations that the company's health plans excluded pregnant women and unhealthy patients in the Illinois Medicaid plan. Medicaid is the state-federal health plan for the poor.
"A settlement of this magnitude sends the clear message that this office takes health care fraud very seriously," said Patrick Fitzgerald, the U.S. attorney for the northern district of Illinois, in a statement...
A jury found Amerigroup liable under federal and state law in October 2006, and the court entered a $334 million judgment against Amerigroup...
Aug 14, 2008
WASHINGTON, Aug 14 (Reuters) - Health insurer Amerigroup Corp (AGP.N: Quote, Profile, Research, Stock Buzz) will pay $225 million to settle federal and state claims of fraud in a government health insurance program, the company and the U.S. Justice Department said on Thursday.
The pact, in coordination with Illinois officials, settles allegations that the company's health plans excluded pregnant women and unhealthy patients in the Illinois Medicaid plan. Medicaid is the state-federal health plan for the poor.
"A settlement of this magnitude sends the clear message that this office takes health care fraud very seriously," said Patrick Fitzgerald, the U.S. attorney for the northern district of Illinois, in a statement...
A jury found Amerigroup liable under federal and state law in October 2006, and the court entered a $334 million judgment against Amerigroup...
Subscribe to:
Comments (Atom)