The Department of Justice (DOJ) in a court filing Thursday dropped a lawsuit alleging that UnitedHealth Group inflated patient risk scores to improperly receive higher reimbursements from Medicare Advantage (MA).
DOJ in March joined the whistleblower lawsuit against UnitedHealth alleging that the insurer had inflated patient risk scores for UnitedHealth enrollees in California.
UnitedHealth in July had requested the case be dismissed, arguing that DOJ "fail[ed] properly to plead two elemental aspects of its claims:
- That United knowingly submitted false attestations; and
- That the government would have refused to pay United's claims if it had know[n] of the truth."
UnitedHealth argued, "Those failings are not careless errors," adding, "Rather, they reflect the broader problem with the DOJ's case, which is that it has attempted to turn a well-known, good-faith disagreement about the meaning of regulatory and statutory language into a False Claims Act suit."
A federal judge on Oct. 5 dismissed the lawsuit, ruling DOJ's allegations were too vague for the case to move forward. The federal judge gave DOJ until Oct. 13 to amend the lawsuit to further support the claims related to alleged misconduct occurring after May 1, 2007.
DOJ drops lawsuit
However, rather than amend the case, DOJ opted to drop the lawsuit. DOJ declined to comment on its decision, according to Reuters.
Matt Burns, a UnitedHealth spokesperson, said, "We are pleased with the government's decision to dismiss these meritless claims."
Here's your cheat sheet for understanding health care's legal landscape
With MACRA, HIPAA, the ACA, and countless others, the health care landscape has become an alphabet soup of legislation. To help you keep up, we've created a series of cheat sheets for some of the most important—and complicated—legal landmarks.
Check them out now for everything you need to know about the Affordable Care Act, antitrust laws, fraud and abuse prevention measures, HIPAA, MACRA, and the two-midnight rule.