UnitedHealth Group, the nation’s largest provider of Medicare Advantage plans, faces a Department of Justice (DOJ) criminal investigation for possible Medicare fraud, according to a report from The Wall Street Journal published Wednesday, May 14. The report says the exact allegations against the company are unclear, but that the inquiry has been underway since at least last summer.
The case is reportedly being handled by the health care fraud unit of the Department of Justice. The Journal did not indicate the likelihood of criminal charges being filed or a timeline for concluding the investigation.
What did UnitedHealth say?
In a statement released Wednesday, UnitedHealth said the DOJ has not notified the company of any investigation. The company also denounced the Journal’s reporting on the matter.
“The WSJ’s reporting is deeply irresponsible, as even it admits that the ‘exact nature of the potential criminal allegations is unclear,’” the statement said. “We stand by the integrity of our Medicare Advantage program.”
Not UnitedHealthcare’s only issue
The reported criminal investigation adds to a list of government inquiries into the company, including an investigation over potential antitrust violations. It also faces a civil investigation of its Medicare billing practices, which began in February.
Also in February, Sen. Chuck Grassley, R-Iowa, launched an inquiry into United’s Medicare billing practices.
Word of this investigation comes just days after UnitedHealth Group’s CEO resigned for personal reasons. The company also suspended its 2025 financial outlook, citing higher-than-expected medical costs.
UnitedHealth’s stock has declined by almost 50% over the past month, and shares plummeted to a four-year low after the Journal’s report was published Wednesday.
The company has dealt with a series of crises over the past year. Hackers disabled a unit that processes payments for health care providers. Additionally, the CEO of its health insurance subsidiary, UnitedHealthcare, was shot to death in what authorities have described as an assassination.
Not just United
UnitedHealth isn’t the only major insurer facing investigations. Earlier this month, the DOJ filed a complaint under the False Claims Act against three of the nation’s largest health insurance companies.
Those companies include Aetna Inc. and its affiliates, Elevance Health Inc., Humana Inc., eHealth, Inc. and an affiliate, GoHealth, Inc., as well as SelectQuote Inc.
The United States alleges that from 2016 through at least 2021 the insurers paid hundreds of millions of dollars in illegal kickbacks to the insurance brokers in exchange for enrollments into those insurers’ Medicare Advantage plans.
