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Justice probing insurers’ Medicare charges, suit reveals

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The U.S. Department of Justice is investigating allegations that some of the nation’s largest health insurers are fleecing the government by overcharging Medicare.

The federal law enforcement agency “has been conducting, and continues to conduct, ongoing investigations” of Los Angeles-based Health Net Inc., Hartford, Connecticut-based Aetna Inc., and Bravo Health Inc. of Philadelphia, which is a unit of Bloomfield, Connecticut-based Cigna Corp. The agency also is investigating Humana Inc., headquartered in Louisville, Kentucky, according to a document filed last week in a qui tam lawsuit against UnitedHealth Group Inc. of Minnetonka, Minnesota.

“Until those investigations are completed, the United States cannot reach a decision about the liability of these other defendants under the False Claims Act … with respect to the truthfulness of their claims to the Medicare Program,” the document, submitted by several federal prosecutors, stated. “Accordingly, the United States lacks sufficient information to make an election decision at this time as to these defendants and will continue its investigations of them independent of this litigation.”

Related: Health insurers lose appeal in whistle blower lawsuit

The document was filed as part of whistleblower Benjamin Poehling’s 2011 qui tam health care fraud lawsuit brought against about a dozen health care companies, including UnitedHealth, alleging that they overstated by millions of dollars how sick their Medicare patients were. Poehling is a former executive at UnitedHealth, the country’s largest insurer.

Last month, the DOJ filed an intent to join the lawsuit against UnitedHealth and WellMed, which is part of UnitedHealth, but declined to intervene in the case against the other insurers. The government said it will file its complaint in the UnitedHealth case by May 16, according to the document filed last week.

“We reject these more than 5-year-old claims and will contest them vigorously,” UnitedHealth spokesman Matthew Burns said in a statement two days after the DOJ announced its plan.

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Aetna and Cigna, which was contacted on behalf of Bravo Health, declined to comment on the DOJ’s ongoing investigation of the companies.

A representative for Humana said via email that the company continues to cooperate with and voluntarily respond to information requests from the DOJ and U.S. attorney’s office.

Health Net did not answer emailed requests for comment on Monday afternoon.


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