Bradley attorney Brad Robertson was quoted in Bloomberg on the recent dismissal of a false claims case against UnitedHealthcare that continues a trend in which courts are ruling in favor of Medicare managed care providers. The U.S. District Court for the Northern District of Illinois dismissed the case because the whistleblower didn’t allege the appropriate facts or point to the proper points in law to move forward with the case.
“The interesting part is that the case deals with Medicare Advantage. The court did a good job of laying out the difference between Medicare Advantage and Medicare Part A or Part B cases,” said Robertson. “It’s a lot harder to say any care they provided or didn’t provide was material to the government payment because the government is paying a dollar amount per person on a prospective basis.”
Robertson explained that this was the latest in a recent trend of false claims cases involving Medicare Advantage, noting whistleblowers will have to expand the types of allegations they bring against companies participating in the managed care program.
“The theories will have to be different than the classic ‘medically unnecessary’ theories of false claims,” Robertson said.
The complete article, “UnitedHealthcare Gets Wal-Mart Card False Claims Case Tossed,” appeared in Bloomberg on June 18, 2018.