United States ex rel. Poehling v. UnitedHealth Group Inc. et al.

Docket No.
2:16-cv-08697
District Court
California Central — Western

Goal

  • Award damages
  • Block defendant action

Issues

Why This Matters:

Why This Matters

A whistleblower, joined in part by the Department of Justice, filed a lawsuit against a group of Medicare Advantage organizations alleging that the defendants violated the False Claims Act by engaging in activities to increase the amount of risk adjustment payments from the government to the organizations. The whistleblower alleges that the defendants sought to increase both the number and the severity of diagnoses submitted to the government to improperly obtain millions of dollars in overpayments from the Medicare program.

Potential Impact:

Potential Impact

Ensuring accurate compensation for Medicare Advantage organizations prevents fraud, protects taxpayer dollars, and keeps health care costs low for patients. The False Claims Act is the government’s primary tool to combat health care fraud, and whistleblower lawsuits play an especially important role in protecting patients and consumers by curbing unnecessary and harmful medical treatments, reducing wasteful spending, and deterring fraud to the tune of nearly 10 times the amount that is recovered.

142 Major Filings

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Related Litigation

Current Status

Briefing is ongoing

Legal Issues

False Claims Act - Submission or Causing Submission of False Claims, False Claims Act - False Records or Statements Material to False Claims, False Claims Act - Overpayment, False Claims Act - Conspiracy to Commit FCA Violations, Unjust Enrichment

Topic(s)

Coding Practices

Date Filed
March 24, 2011
Case Type
Civil
Court Type
District Court
Court
California Central
Division
Western
Judge
Olguin, Fernando M. Appointed By: Barack Obama
Plaintiff(s)
Benjamin Poehling
Lead Counsel For Plaintiff(s)
Whistleblower Partners LLP
Intervenor Plaintiff(s)
United States
Amicus Briefs for Plaintiff(s)

Members of Congress

Defendant(s)
UnitedHealth Group Inc.; United HealthCare Services Inc.; UnitedHealthcare Inc.; UnitedHealthcare Insurance Company; UHIC Holdings Inc.; Ovations Inc.; OptumInsight Inc.; Optum Inc.; AmeriChoice of New Jersey Inc.; Arizona Physicians IPA Inc.; Care Improvement Plus of Maryland Inc.; Care Improvement Plus of Texas Insurance Company; Care Improvement Plus South Central Insurance Co.; Care Improvement Plus Wisconsin Insurance Company; Catamaran Insurance of Ohio Inc.; Citrus Health Care Inc.; Health Plan of Nevada Inc.; Medica HealthCare Plans Inc.; Oxford Health Plans (CT) Inc.; Oxford Health Plans (NJ) Inc.; Oxford Health Plans (NY) Inc.; PacifiCare Life and Health Insurance Company; PacifiCare of Arizona Inc.; PacifiCare of Colorado Inc.; PacifiCare of Nevada Inc.; Physicians Health Choice of Texas LLC; Preferred Care Partners Inc.; Rocky Mountain Health Maintenance Organization Inc.; Sierra Health and Life Insurance Company Inc.; Symphonix Health Insurance Inc.; UHC of California Inc.; Unison Health Plan of Tennessee Inc.; United Health Care Ins. Co. and United New York; UnitedHealthcare Benefits of Texas Inc.; UnitedHealthcare Community Plan of Ohio Inc.; UnitedHealthcare Community Plan of Texas LLC; UnitedHealthcare Community Plan Inc.; UnitedHealthcare Insurance Company of New York; UnitedHealthcare Insurance Company; UnitedHealthcare of Alabama Inc.; UnitedHealthcare of Arizona Inc.; UnitedHealthcare of Arkansas Inc.; UnitedHealthcare of Florida Inc.; UnitedHealthcare of Georgia Inc.; UnitedHealthcare of New England Inc.; UnitedHealthcare of New York Inc.; UnitedHealthcare of North Carolina Inc.; UnitedHealthcare of Ohio Inc.; UnitedHealthcare of Oklahoma Inc.; UnitedHealthcare of Oregon Inc.; UnitedHealthcare of Pennsylvania Inc.; UnitedHealthcare of Tennessee Inc.; UnitedHealthcare of the Midlands Inc.; UnitedHealthcare of the Midwest Inc.; UnitedHealthcare of Utah Inc.; UnitedHealthcare of Washington Inc.; UnitedHealthcare of Wisconsin Inc.; UnitedHealthcare of the River Valley Inc.
Lead Counsel for Defendant(s)
Latham & Watkins LLP