AGG Files Amicus Brief on Behalf of 29 Congress Members in UnitedHealth Medicare Advantage Fraud Case

AGG attorneys Rich Collins, Jennifer Shelfer, and Kelley Chandler filed an amicus brief on behalf of 29 Congress members, led by U.S. Rep. Pramila Jayapal, in United States of America v. UnitedHealth Group, Inc. et al, a case alleging that UnitedHealth defrauded the Medicare Advantage program by using inaccurate diagnosis codes to make beneficiaries appear sicker than they actually are, which resulted in inflated payments to United. In the brief, AGG urged the federal judge in the U.S. District Court for the Central District of California to reject a special master’s recommendation to dispose of the case and allow the case to proceed to jury trial.

The lawsuit alleges that UnitedHealth illegally kept overpayments from the Medicare Advantage program despite knowing that patients’ diagnoses were not supported in medical charts, leading to billions of dollars of losses by the federal government.

“The Medicare Payment Advisory Committee estimates [Medicare Advantage] plans will be overpaid by $1.2 trillion between 2025-2034, with $520 billion paid by the Medicare Hospital Insurance trust that funds Medicare Part A,” the attorneys said in the brief. “According to the report, these higher payments to plans are largely due to favorable selection and coding intensity, both of which are at issue in this case and both drive the fraud, waste, and abuse in the MA program.”

“A ruling in favor of United would dispose of the present case prematurely before a jury has the opportunity to weigh in on United’s conduct, and would embolden other insurers to continue gaming the MA program with practices that harm American taxpayers and the elderly,” the attorneys continued.

With one of the most aggressive and respected reimbursement practices in the country, AGG is committed to leveling the playing field against large insurance companies to help healthcare providers and patients recover the reimbursement they deserve. AGG is honored to help serve as the voice of these Congress members who are responsible for legislating and funding Medicare Advantage, which covers 35 million people.

“UnitedHealth must answer to a jury, to the allegations that its network of [Medicare Advantage] plans intentionally ‘upcoded’ to increase the payments it received from Medicare — taxpayer dollars that did not go to provide healthcare to patients, but rather to pad UnitedHealth’s profits,” said Rep. Jayapal. “Americans deserve to know if Medicare funds have been — and could continue to be — abused.”

To read the full amicus brief, please click here.