DOJ Pushes On Against UnitedHealth Despite Special Master's Report

The U.S. Department of Justice continues its whistleblower lawsuit against UnitedHealth Group, despite a March report from a special master which found there was a 'complete failure' of evidence against the company. The case centers on allegations that UnitedHealth improperly retained $2.1 billion in Medicare Advantage payments after medical coders failed to report unsupported medical codes. The government argues that the special master's conclusion is flawed and that a jury should evaluate the conflicting evidence regarding the validity of the diagnosis codes submitted by UnitedHealth. The legal battle continues as the federal judge is set to review the special master's report shortly.

In its initial findings, the special master determined that the Justice Department did not provide sufficient evidence to justify a trial against UnitedHealth, leading to a recommendation for summary judgment in favor of the company. The Justice Department's recent filing disputes this conclusion, stating that the special master incorrectly assessed the evidence and the implications of the law regarding false claims. UnitedHealth Group continues to defend its position, asserting that the DOJ's view on diagnosis codes lacks evidential support and misrepresents the coding process in medical claims.