March 4 (Reuters) - A court-appointed special master has
found that U.S. authorities do not have evidence to support
their billion-dollar fraud case accusing UnitedHealth Group ( UNH )
of keeping overpayments from the government for patients
on its Medicare insurance plans.
The recommendation by Special Master Suzanne Segal on Monday
is not a final ruling, but if it is adopted by U.S. District
Judge Fernando Olguin, it would end the U.S. Department of
Justice's claims against the health insurer.
"After more than a decade of DOJ's wasteful and expensive
challenge to our Medicare Advantage business, the Special Master
concluded there was no evidence to support the DOJ's claims we
were overpaid or that we did anything wrong," UnitedHealth ( UNH ) said
in a statement.
The Justice Department did not immediately respond to a
request for comment.
The government claimed in its 2016 lawsuit that UnitedHealth ( UNH )
submitted false diagnoses for patients on its government-funded,
privately administered Medicare Advantage plans in order to get
higher payments. Medicare reimbursements to insurers that
administer Medicare Advantage plans are tied to patients'
diagnosis codes, with sicker patients getting higher
reimbursements.
However, Segal wrote on Monday that the government's case
relied on discrepancies between diagnoses submitted by doctors
making claims and later determinations by UnitedHealth's ( UNH ) coders.
She said that did not show that any of the original claims were
false, concluding that there "simply was no fraud."