In July 2021, UnitedHealth Group (UHG) announced that it had entered into a Corporate Integrity Agreement (CIA) with the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS). This announcement came after UHG had settled two separate lawsuits related to allegations of overcharging and falsifying claims to the Medicare program.

A CIA is a formal agreement between a company and the government that outlines specific actions and requirements that the company must take in order to maintain compliance with federal healthcare program requirements. This agreement typically lasts between five and ten years and includes regular reporting to the OIG and outside independent reviewers.

Under the terms of the CIA, UHG is required to implement several compliance-related measures, including:

– Enhancing its compliance program by implementing a new compliance risk framework and conducting regular compliance training for employees and contractors.

– Establishing an independent review organization to oversee UHG`s compliance program and report directly to the OIG.

– Conducting regular monitoring and auditing of UHG`s claims processing systems and refunding any overpayments identified through these reviews.

The CIA also requires UHG to pay $60 million to the federal government to settle the two lawsuits alleging overcharging and falsifying claims to Medicare. These lawsuits were brought by two whistleblowers who alleged that UHG had engaged in improper billing practices that resulted in inflated payments from Medicare.

UHG has stated that it is committed to maintaining compliance with all healthcare program requirements and that it takes these allegations very seriously. The company has also stated that it has already begun implementing the required compliance measures and that it will continue to work closely with the OIG to ensure that it remains in compliance with the terms of the CIA.

The CIA is a reminder that compliance with federal healthcare program requirements is critically important for companies operating in the healthcare industry. Companies that fail to comply with these requirements risk facing significant legal and financial penalties, as well as damage to their reputation. It is essential that companies take proactive steps to ensure compliance, including regularly reviewing and updating their compliance programs.

In conclusion, the UHS Corporate Integrity Agreement serves as a cautionary tale for other healthcare companies that may be engaging in improper billing practices. It is important for companies to take compliance seriously and to work closely with regulatory agencies to maintain compliance and avoid costly legal and financial consequences.