A district court dismissed a suit claiming UnitedHealthcare violated the Anti-Kickback Statute by providing $25 Walmart gift cards to Medicare beneficiaries who opted to receive free in-home exams.
Judge Thomas Durkin of the Northern District of Illinois Eastern Division issued a 27-page opinion and order that dismissed claims filed by Jeffrey Gray, a realtor and UnitedHealthcare Medicare Advantage beneficiary. In his lawsuit, Mr. Gray claimed UnitedHealthcare violated the Anti-Kickback Statute by offering Medicare Advantage beneficiaries Walmart gift cards for receiving in-home physician exams through its HouseCalls program.
Mr. Gray argued the visits were improper, as physicians did not certify them as medically necessary. UnitedHealthcare used the ICD-9 codes generated from these exams to inflate risk adjustment scores, leading to overpayments from CMS, according to the lawsuit.
However, the judge ruled Mr. Gray's lawsuit "is too speculative" and "provides no concrete allegations to support its plausibility." In addition, the order states Mr. Gray's case failed to show the government would not have made payments had it known about the alleged violations.
Mr. Gray can file an amended complaint by July 3.
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