UnitedHealthcare, one of the nation’s largest health insurers, may have improperly taken billions of dollars from Medicare by claiming for years<br />that people under its care were sicker than they were, according to a lawsuit made public Thursday at the Justice Department’s request.<br />Instead of slowing Medicare costs, UnitedHealthcare may have improperly added excess cost running into the billions<br />of dollars over more than a decade, according to documents unsealed in Federal District Court in Los Angeles.<br />The allegations were first made in 2011, when a former UnitedHealthcare executive, Benjamin Poehling, filed a complaint under the False Claims Act, a federal law<br />that lets private citizens take legal action when they believe a government program has been defrauded.<br />The accusations at issue in the suit center on Medicare Advantage, a program through which people 65 or older agree<br />to join private health maintenance organizations, or H. M.O.s, whose costs are reimbursed by the government.<br />In its own filing this week, the Justice Department asked the court to grant access to all documents produced as<br />Mr. Poehling’s case against the other defendants proceeds, and it reserved the right to join those cases later.<br />The program was created in 2003 after UnitedHealthcare and other insurers said<br />that managed care could help hold down the overall cost of Medicare, which has strained the federal budget by rising faster than the rate of inflation.
