Talking About Real Money

Kaiser Health News reports that UnitedHealth, a major managed health care company, is being charged by the Justice Department with fraud in the management of their Medicare Advantage programs:

The Justice Department on Tuesday accused giant insurer UnitedHealth Group of overcharging the federal government by more than $1 billion through its Medicare Advantage plans.

In a 79-page lawsuit filed in Los Angeles, the Justice Department alleged that the insurer made patients appear sicker than they were in order to collect higher Medicare payments than it deserved. The government said it had “conservatively estimated” that the company “knowingly and improperly avoided repaying Medicare” for more than a billion dollars over the course of the decade-long scheme.

A billion here and a billion there and pretty soon you’re starting to talk about real money. $1 billion is not a negligible sum, even for UnitedHealth which accounts for about a third of all of those covered under Medicare Advantage plans.

It also makes me wonder about the other plans.

7 comments… add one
  • Jan

    If real scrutiny were applied to not only healthcare programs but all government run ones, I think the fraud, abuse and waste (over billing or misdirection of funds) would absolutely be stunning!

  • It think it’s the words “conservatively estimated” in the Justice Department quote that should worry us. A billion is already 2% of UnitedHealth’s gross receipts on its Medicare Advantage plans.

  • TastyBits

    I have been assured that companies are too concerned about the customers to do anything untoward, but if true, it was likely just one or two bad apples. Why are we wasting money by allowing the Justice Department to investigate businesses or their practices.

  • walt moffett

    Makes me wonder what the auditors are really looking at and under what set of rules.

  • Steve

    If they ever want to investigate the for profit hospitals they could easily garner many more billions in fines. However we are missing a bit of key information here. The UnitedHealth Group CEO is now the clear front-runner for becoming the next governor of Florida.


  • ?

    Stephen Helmsley lives in Minnesota. He’s running for governor of Florida?

  • steve

    Was making a Rick Scott reference. Running a health care scam while a CEO at health care company didn’t deter him and actually seemed to better qualify him of some voters.


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