Healthcare Fraud Lawyer Blog
There are currently two False Claims Act (FCA) qui tam cases against United Health Group (UHG) pending in the Central District of California. The cases are: U.S. ex rel. Benjamin Poehling v. UnitedHealth Group, Inc. and U.S. ex rel. Swoben v. Secure Horizons, et al. The cases were brought by James Swoben, who was previously an employee of Senior Care Action Network Health Plan and a consultant within the risk adjustment industry, and Benjamin Poehling, who was the former finance director of a UHG group that managed the insurer’s Medicare Advantage Plans.
The Qui Tam Cases Against UHG
On May 2, the U.S. intervened in the Swoben False Claims Act suit against UHG based on the allegations the insurer overcharged Medicare Advantage and prescription drug programs. In the DOJ’s complaint, it alleges the insurer knowingly ignored patients’ medical conditions to increase payments it received from Medicare and funded chart reviews to increase the risk adjustment payments it reviewed. However, any information the reviews uncovered regarding misdiagnoses were disregarded to avoid repaying Medicare.
rise. In May 2010, as alleged in court filings, Tai took over operations at United Medical Diagnosis (“UMD”), a radiology clinic in Flushing, New York. From May 2010 through May 2012, Tai and his staff allegedly used the identity of the clinic’s prior owner, a radiologist, to submit more than $30 million in claims to Medicare and Medicaid. The claimed services were not actually performed and the bills were submitted without the knowledge or consent of the former UMD owner. United States Attorney Loretta Lynch explained, “The defendant sought to enrich himself and fund his lifestyle first by stealing a doctor’s identity and then using that stolen identity to steal Medicare and Medicaid funds…While the documentation provided was a sham, the money stolen was very real.”