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Health insurers lose appeal in false-claims suit over one-sided reviews

An appeals court says a whistleblower has made a strong case that major insurers like UnitedHealthcare, HealthCare Partners, and Aetna violated the False Claims Act by skewing their Medicare reporting to draw bigger government payments.

By Ben Hancock | Updated on August 11, 2016
An appeals court says a whistleblower has made a strong case that major insurers like UnitedHealthcare, Aetna, and others, skewed their Medicare reporting. (Photo: AP)

A federal appeals court has breathed new life into a qui tam action, or whistleblower lawsuit, alleging that some of the nation’s largest health insurers have been systematically fleecing the government.

In an opinion published Wednesday, the U.S. Court of Appeals for the Ninth Circuit said that whistleblower James Swoben had made a strong case that major insurers like UnitedHealthcare, HealthCare Partners and Aetna violated the False Claims Act by skewing their reporting of patient health data to draw bigger government payments.

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