Minnetonka, Minn.-based UnitedHealthcare has agreed to pay $3.5 million to settle whistleblower allegations that the company's telephone response unit knowingly mishandled phone calls from Medicare beneficiaries and providers to obtain higher reimbursements, according to the U.S. Justice Department.
The Justice Department alleged that between 1996 and 2000, the unit falsely reported its performance to the CMS to mislead the agency into paying the Medicare durable medical equipment carrier more money to disguise its performance. UnitedHealthcare served as the DME carrier in the northeastern U.S. from 1995-2000, processing DME claims from Medicare beneficiaries and their healthcare providers and DME suppliers.
The CMS establishes certain performance standards by which it measures and compensates carriers and fiscal intermediaries. "This settlement demonstrates our continuing commitment to pursue vigorously allegations of fraud and abuse in Medicare," said Assistant Attorney General Peter Keisler, who heads the Justice Department's civil division, in a news release. "Medicare contractors, along with other health care providers, can and will be held accountable for their billing practices."
The whistleblower, a former UnitedHealthcare employee, filed the federal False Claims Act suit under seal in 2001. UnitedHealthcare is one of more than a dozen fiscal intermediaries and carriers who have settled Medicare fraud allegations with the Justice Department.
UnitedHealthcare officials could not be reached for comment at deadline.
UnitedHealth Group, the healthcare-benefit company's parent, in a news release said "these reporting errors pertain to an administrative business unit that UnitedHealth Group exited four years ago" and "did not involve any allegations of wrongdoing related to UnitedHealth Group's current business with the federal government, specifically our Medicare Supplement or Medicare Advantage HMO or PPO business."
UnitedHealth Group said it "discovered inherited problems in that business, promptly self-reported them, and cooperated fully with federal oversight agencies."