Big-name medical care provider targeted in DOJ fraud probe

Most of our readers in Houston and across Texas have likely heard the adage, “The bigger they are, the harder they fall.”

When it comes to companies suffering material downsides from the adverse fallout linked with a criminal and/or regulatory fraud-connected probe, a corollary might readily be tacked on to that maxim.

And that is this, namely, that the bigger an enterprise is, the greater is its comparative need for proven and aggressive legal counsel when it is spotlighted by state or federal authorities for alleged wrongdoing regarding fraudulent behavior.

Now, here’s a central point about UnitedHealth Group: the managed health care company is truly big.

In fact, it is a colossus in its industry, with virtually everything it does being duly noted by media outlets across the country.

And that is especially true when, as was the case recently, it was pointed to by the United States Department of Justice as acting criminally in a long-tenured and large-scale way by purposefully submitting false billings to the government for payment in Medicare cases.

The DOJ specifically alleges that the country’s largest health insurer passed along bills for payment over many years containing medical diagnostic codes that it knew “were not supported by patients’ medical records.”

Federal authorities filed a lawsuit against UnitedHealth last week in Los Angeles, intervening in the fraud cases following litigation commenced earlier by two whistleblowers.

We have noted in past select posts that health care fraud has been an uppercase focus for government regulators and law enforcers for the past several years.

The UnitedHealth Group case certainly underscores that reality.