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UnitedHealth Group False Claims Suit Back on Track

Margaret Dick Tocknell, for HealthLeaders Media, July 6, 2011

A ruling by the Third Circuit Court of Appeals in Philadelphia will allow a portion of a kickback case against UnitedHealth Group Inc. and its subsidiary, AmeriChoice New Jersey, to proceed. A  three-judge panel made the ruling in an appeals case from district court.

The whistleblower suit involves charges by two former employees that UHG and AmeriChoice provided kickbacks to a New Jersey medical clinic to induce the clinic to switch its patients to the healthcare provider's Medicare and Medicaid programs.

Charles Wilkins and Daryl Willis also alleged that AmeriChoice violated the Medicare Anti–Kickback Statute by “enticing doctors to provide the names of patients eligible for Medicare and Medicaid programs” and that the insurers “knowingly violated several Medicare marketing regulations, resulting in their submission of false claims for payment to the federal government.”

The Third Circuit last week affirmed the district court’s May 2010 dismissal of False Claim Actallegations based on UHG and AmeriChoice’s violation of Medicare marketing regulations. However, it remanded part of the case back to district court for further proceedings.

According to the ruling the district court erred in granting the motion to dismiss the portion of the suit that involves allegations that UHG and AmeriChoice submitted false claims to the government by violating the Medicare Anti-Kickback Statute.

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