Is it Kosher for United Health to Be Judging What’s “Appropriate” in Medicare Billing Practices?

When the fox is guarding the hen house, don’t be surprised if you get fewer eggs.

Such may be the case now that it’s become clear that one of the U.S.’s largest health insurance companies, United Health, has found a way to become the “figurative fox” in the current debate about Medicare billing fraud. The insurance firm owns Executive Health Resources, a consulting firm that aids doctors and hospitals in streamlining their billing procedures. This consultancy has assisted over half of the nation’s hospitals in their billing statements to Medicare.

Of course, the company maintains it is completely impartial and is only looking to make sure that billing procedures are streamlined, efficient and accurate.

Perhaps, however, Executive Health charges up to $250 per claim review and is paid as much as $1 million annually by certain hospitals. Further, the company repeatedly has stressed confusion and frustration over what it terms as “gray areas” in Medicare’s rules. Executive Healthcare is also quick to boast about its successful appeals in that it aids hospitals that fight back against alleged overbilling. One such entity, Community Hospital of the Monterey Peninsula in California, praised Executive Health as being the hospital’s advocate against the government’s confusing policies.

The U.S. government isn’t nearly as impressed with circumspect hospital billing trends. It has launched a lawsuit against these billing policies and expects to hear from Executive Health leaders about the company’s role in allegedly rooting out bad billing policies. The government points Singing River Hospital in Mississippi which denied overbilling because it believes an analysis by Executive Health exonerated the hospital from any wrongdoing in a report. Government auditors rejected the findings and did not change its ruling.

If you are aware of shady billing practices or other violations of the Consumer Fraud Act, you may have a whistleblower claim. Contact the qui tam attorneys at Begelman & Orlow, P. C. to discuss your concerns. With more than 115 years of combined experience litigating whistleblower cases throughout the U.S., they can help determine if you have a valid case.