United Healthcare concealed enrollment fraud complaints, lawsuit claims
UnitedHealthcare has found itself on the receiving end of another lawsuit, this time alleging the insurance giant of concealing complaints of enrollment fraud and other issues.
The whistleblower lawsuit, which was filed in 2016 but unsealed last week, claims United kept a “dual set of books” to keep complaints hidden and was “intentionally ineffective” at looking into sales employees' misconduct.
Among those allegations of misconduct are claims that United knew that one agent had forged beneficiaries' signatures on enrollment forms. Another agent reportedly engaged in a kickback scheme in which she told beneficiaries they would receive an iPad if they signed up for an insurance plan and stayed with it for six months.
In total, the company informed the Centers of Medicare & Medicaid Services of just 257 serious complaints in March 2016, compared to the 771 that were logged, Kaiser Health News reported. The lawsuit argues that United intentionally hid the misconduct complaints in order to maintain its federal ratings.
A representative of United told KHN the company rejects the claims included in the suit.
The lawsuit's unsealing hit as United is facing a complaint from the Department of Justice. It says the insurance provider “knowingly disregarded” beneficiary information in order to receive higher Medicare Advantage payments.