What do you do if you are a billing employee for a health care entity in Connecticut or elsewhere — a doctor’s office, say, or a hospital, clinic, pharmacy, medical device maker, pharmaceutical manufacturer or other participant — and you note an incongruity between a product or services code and what a patient or other party actually received?
Do you promptly flag the disconnect and fix it?
Or, alternatively, do you push your billing through and accept any extra and unwarranted payment that comes in from a payer?
The answer to that is quick and obvious right? Ethical considerations and, importantly, legal imperatives mandate that you simply do what’s right: you duly attend to discrepancies and take every action necessary to avoid cheating a patient or customer.
Given that this is a consumer fraud post, it’s a given what billers from UnitedHealth Group — the country’s largest health insurer — allegedly did with a large number of patient diagnostic codes for over a decade.
According to the U.S. Department of Justice, they bilked the nation’s taxpayers by demanding payment for Medicare patients relevant to services that they did not actually provide.
And that alleged fraud resulted recently in the DOJ intervening in a pair of whistleblower lawsuits filed earlier this year against the health care company.
The government’s lawsuit, filed in a Los Angeles federal court, contends that the company’s wrongdoing transcended purposeful inaction in the face of fraud that it knew was being perpetrated on the public. The complaint stresses that UnitedHealth principals actually encouraged submission of false information.
And they will now pay for that, says the DOJ.
“This action will send a warning,” stated one government spokesperson in the wake of the DOJ’s intervention.