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U.S. can sue UnitedHealth in $1 billion Medicare case, judge rules

From Reuters - February 13, 2018

(Reuters) - A federal judge has ruled the U.S. Justice Department can move forward with a lawsuit claiming UnitedHealth Group Inc wrongly retained more than $1 billion from the government healthcare program Medicare.

U.S. District Judge Michael Fitzgerald in Los Angeles on Monday ruled that the department had sufficiently alleged UnitedHealth submitted invalid diagnostic data related to the health status of patients enrolled in Medicare Advantage plans.

But Fitzgerald dismissed claims that the insurer falsely attested to the datas validity, saying the key allegation that those assurances affected payment decisions by the U.S. Centers for Medicare and Medicaid Services was missing.

Fitzgerald said that while the data itself appeared to be material to the agencys payment decisions, the allegations regarding the assurances UnitedHealth made about the data do not suggest they are likely to influence the payment of money.

UnitedHealth in a statement on Tuesday said it rejects the Justice Departments remaining claims and will continue contesting them. The Justice Department had no immediate comment.

Fitzgeralds decision to dismiss part of the case was based on a 2016 U.S. Supreme Court decision regarding what must be alleged under the False Claims Act to prove a companys false statement was material to the government paying it.

That law allows the government and whistleblowers suing on its behalf to recover taxpayer money paid to companies based on fraudulent claims.

If successful, whistleblowers receive a percentage of the recovery. The government may intervene in whistleblower lawsuits, typically a major boost to those cases.

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