The U.S. Justice Department is investigating several health insurers over whistle-blower allegations that they fraudulently collected millions in Medicare payments by claiming patients were sicker than they actually were.
The Justice Department said it continues to investigate Aetna, Cigna's Bravo Health, Health Net and Humana, according to a court document filed Tuesday in a Los Angeles federal court.
The allegations against the four health insurers are part of a False Claims Act lawsuit that makes similar claims against UnitedHealth Group, the nation's largest insurer.
Last month, the Justice Department joined the lawsuit against Minnetonka, Minn.-based UnitedHealth, but declined to intervene against the other insurers named in the suit.
In Tuesday's filing, the agency said it cannot make a decision about whether to intervene against the other insurers until it completes its investigations.
“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,” the Justice Department said.
The lawsuit was initially brought in 2011. It alleges that the insurers inflated plan members' risk scores since at least 2006 in order to boost payments under Medicare Advantage's risk-adjustment program.
UnitedHealth, for example, allegedly collected payments from false claims that it treated patients for conditions they didn't have, for more severe conditions than they had, conditions that had already been treated, or diagnoses that didn't meet the requirements for risk adjustment, according to the complaint.
The lawsuit also said that in 2010, UnitedHealth planned to increase operating income by $100 million through "Project 7," which was the company's code word for initiatives to increase risk-adjustment payments.
A UnitedHealth spokesman last month said the insurer would contest the claims.
Payment rates in Medicare Advantage are based on regional trends and utilization in traditional fee-for-service Medicare as well as adjustments to plan members' risk scores, among other variables. Under the Medicare Advantage program, the government pays private health plans monthly amounts for every member they cover, and those taxpayer-funded payments are adjusted based on how sick someone is.
Members with more chronic conditions have higher risk scores, and plans that cover them receive higher payments. These risk scores were created to incentivize plans to cover all seniors regardless of their health status, but there have been several whistle-blower lawsuits in recent years that allege health plans have been inflating the scores to collect more funds.
