A special master has recommended dismissing a decade-old lawsuit against UnitedHealth Group<\/a> that alleged Medicare Advantage overcharging. In a March 3 report, Suzanne Segal, a retired judge appointed as special master in 2020, stated the government lacked sufficient evidence to support its claims. The federal judge overseeing the case will determine whether to adopt this recommendation.<\/p>\n The lawsuit originated in 2011 through a whistleblower, with the Justice Department joining in 2017. The government alleged UnitedHealth received $2.1 billion for Medicare Advantage diagnoses not supported by medical records between 2010 and 2017. According to Segal, the Justice Department failed to prove these claims lacked medical record support.<\/p>\n After over a decade of litigation, Segal noted the government had not reviewed a single medical chart relevant to the case. “The government must now accept the consequences of that decision, which is that its experts are left hopelessly unable to say which (if any) of the diagnosis codes at issue are unsupported,” she wrote in her report.<\/p>\n UnitedHealth shares increased slightly following the decision. The company stated: “After more than a decade of DOJ’s wasteful and expensive challenge to our Medicare Advantage business, the special master concluded there was no evidence to support the DOJ’s claims we were overpaid or that we did anything wrong.” The Justice Department is objecting to the decision.<\/p>\n This case occurs amid wider scrutiny of Medicare Advantage billing practices. The Wall Street Journal reported in February that the DOJ is investigating UnitedHealth’s Medicare Advantage billing practices, which the insurer disputes. Senator Chuck Grassley has launched an inquiry into these practices as well. Medicare Advantage plans receive federal reimbursements based on beneficiaries’ health risk status, with nearly every major plan facing upcoding allegations. According to a 2024 HHS Office of Inspector General report, Medicare Advantage companies received $7.5 billion in “questionable” payments in 2023.<\/p>\n Discover the latest payers’ news updates<\/strong><\/a> with a single click. Follow DistilINFO HealthPlan<\/a> and stay ahead with updates. Join our community today!<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"Case Background and Government Allegations<\/h2>\n
Evidence Challenges Highlighted<\/h2>\n
Reactions from Involved Parties<\/h2>\n
Broader Medicare Advantage Scrutiny<\/h2>\n