MAP Fraud

The DOJ is suing UnitedHealth, accusing the nation’s largest MAP of exploiting the program by providing inaccurate information about the health of its enrollees. DOJ alleges the practices have led to damages of more than $1.14 billion from 2011-2014.

In separate news, two Florida MAPs, Freedom Health and Optimum HealthCare, recently agreed to pay nearly $32 million to settle a whistleblower lawsuit that alleged they exaggerated how sick patients were and took other steps to overbill the government health plan for the elderly.

Politicians have made a living by promoting the idea that Medicare and Medicaid programs are rife with fraud. No politician in recent history has focused on the track record of MAPs (Care or Caid) in either perpetrating or uncovering fraud. The truth is commercial insurers do not bother auditing for fraud (perhaps because they know they live in extremely fragile glass houses) but instead simply rely on their age old tactic of denying claims to “save” money. It is a fascinating illustration of how politicians control the narrative by creating myths people accept as gospel.

I seriously doubt these recent stories about fraud in the MAP sector will become part of the political narrative.