Whistleblowers Expose Possible Billion Dollar Loss in Medicare Fraud Case

Michael S. Callahan | | Whistleblower
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When healthcare companies overcharge the federal government for services, taxpayers ultimately get socked with the bill – Happens in Houston, in Texas and in the rest of the country.

Sometimes big companies do bad things. Take healthcare companies as an example. When healthcare companies overcharge the federal government for services, taxpayers ultimately get socked with the bill. Whistleblower laws allow employees to put a stop to the abuse and receive compensation from the recovered losses. Cases currently pending against United Healthcare potentially involve billions in fraudulent charges to Medicare. This can happen in Houston and Texas and around the country.

Allegation: UnitedHealth Said “Step On The Gas!”

According to Fierce Healthcare, lawsuits filed by two whistleblowers, Benjamin Poehling and James Swoben against United Healthcare charge that the company implemented a plan to inflate patients’ “risk code”, called “upcoding”, in order to increase government reimbursements. The U.S. Justice Department is investigating United Healthcare along with Aetna, Humana, Health Net and Bravo Health, part of Cigna for similar schemes.

The Minneapolis Star Tribune reports in the Poehling suit that United evaluated employees on their success at maximizing revenue through risk adjustment.

UnitedHealth’s attitude about the possibilities with risk adjustment is summarized, the lawsuit says, by an internal e-mail between executives with the subject line “Step on the Gas” that stated: “You mentioned vasculatory disease opportunities, screening opportunities, etc., with huge dollar opportunities. Let’s turn on the gas!”

The suit alleges that United Healthcare officials used secret names concocted to camouflage efforts to boost revenue through upcoding.

At one point, UnitedHealth officials launched initiatives under the code word “Project 7” to describe strategies for boosting risk adjustment payments, according to the lawsuit. The company used a code word “because it did not want CMS or other investigatory government agencies to know it had a campaign to claim an additional $100 million through risk score increases,” the lawsuit states.

Attorneys in the suits estimate that the potential recovery could run to the hundreds of millions if not billions of dollars. Cases of Medicare fraud running to the hundreds of millions are not new, as the dialysis clinic chain DaVita later settled on a $450 million payment after these two employees brought a whistle blower case against it:

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Whistleblowers Benefit by Bringing Justice – And Can Be Protected

Insurance companies, doctors and clinics that scam the Medicare system waste billions of dollars that could be helping with legitimate needs of elderly patients. Instead, hardworking tax payers pay for bogus billing.

Whistleblowers such as Poehling file suits alleging fraud on behalf of the federal government and are known as “relators”. They are able to receive a portion of damages recovered, a strong incentive to come forward and expose abuse.

The law protects whistleblowers from retaliation for coming forward with evidence of fraud. If you have a whistleblower case and are seeking legal guidance, our whistleblower lawyers are here to offer experienced advice and determined advocacy.

Contact The Callahan Law Firm for a Free Case Evaluation.