Federal judge dismisses UnitedHealth fraud suit over in-home visits, Walmart gift cards

Gavel court room lawsuit judge
A federal judge ruled that the plaintiff's complaint contained deficiencies including failure to prove that UnitedHealth’s actions violated federal law. (Pixabay)

A federal judge has dismissed a lawsuit against UnitedHealthcare accusing the insurer of fraud over in-home clinical visits and a $25 Walmart gift card.

In the decision (PDF), Illinois District Court Judge Thomas M. Durkin ruled that the plaintiff's complaint contained deficiencies including failure to prove that UnitedHealth’s actions violated federal law. But he left open the opportunity for the whistleblower to file an amended complaint by July 3. 

The lawsuit stemmed from the Minnesota-based insurer's "HouseCalls" program that sends licensed providers to beneficiaries’ homes to conduct in-home physical examinations.


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The plaintiff said he initially declined an offer for a Medicare Advantaged-covered HouseCalls visit, but changed his mind after he was offered a $25 Walmart gift card, which he later claimed was in violation of the Anti-Kickback Statute.

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Following the in-home exam, and delivery of the promised gift card, the plaintiff alleged that the in-home visits were improper as they were not medically necessary and that as a result of United’s improper submission and certification of the data obtained from the exams, Medicare overpaid the insurer.

The Centers for Medicare & Medicaid Services "has stated that it will not exclude, for payment purposes, diagnoses obtained through in-home examinations," the ruling said. 

UnitedHealthcare did not immediately respond to FierceHealthcare's request for comment.

The lawsuit is the latest in a string of legal victories for UnitedHealth. A Florida federal judge dismissed in May Envision's lawsuit against the insurer over a contract dispute involving staffing and payments.

Several high-profile fraud lawsuits involving UnitedHealth's Medicare Advantage program have also fallen apart in recent months. Earlier this year, federal prosecutors abandoned most of a lawsuit that claimed the insurer inflated risk scores to overbill federal programs. That came months after the DOJ backed out of a second fraud lawsuit against UnitedHealth that included similar claims. 

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