Dismissal of Medicare Advantage FCA Suit Marks Significant Defeat for Government

October 10, 2017
Inside the FCA Blog

Background

The U.S. District Court for the Central District of California recently dismissed a complaint-in-intervention filed by the U.S. Department of Justice (DOJ) in U.S. ex rel. Swoben v. Secure Horizons. As previously reported, in this significant test case, DOJ filed its complaint on May 1, 2017, as to the UnitedHealth Group parties (collectively, UnitedHealth), marking the first time that DOJ joined a whistleblower suit alleging FCA violations regarding Medicare Advantage. The complaint alleged that the “risk adjustment” payments, which account for the severity of patient conditions as compared to an average Medicare fee-for-service beneficiary, were boosted by ignoring questionable diagnoses.

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Bass, Berry & Sims’ Inside the FCA blog features news, commentary and thought leadership covering FCA, healthcare fraud and procurement fraud.