DOJ investigating UnitedHealth over Medicare Advantage billing: Report

• The DOJ has launched a civil fraud investigation into UnitedHealthcare over its billing practices in the Medicare Advantage program, according to the Wall Street Journal. The investigation focuses on whether the healthcare giant artificially inflated patient diagnoses to increase its monthly payments from the government.
• In a statement, UnitedHealth Group called reporting by the Journal “outrageous and false” and accused the outlet of reporting “misinformation” about its partnership with Medicare Advantage.
• This investigation is just the latest in a series of scandals to have dogged the healthcare giant since last year.

Full Story

UnitedHealthcare is currently under investigation by the U.S. Department of Justice (DOJ), according to a recent report from the Wall Street Journal. The government has launched a civil fraud investigation, looking at whether the embattled healthcare giant is illegally inflating its monthly payments received by the Medicare Advantage program, using patient diagnoses.

Medicare Advantage is a division of Medicare, the public health insurance program that serves more than 65 million elderly and disabled Americans. According to the U.S. Department of Health and Human Services (HHS), Medicare Advantage enrollees sat at roughly 25% in 2010. By 2024, that number had risen to 54%, according to the nonprofit health policy research firm KFF.

The investigation into UnitedHealthcare is being led by the DOJ’s civil fraud division and HHS’ inspector general’s office.

Download the SAN app today to stay up-to-date with Unbiased. Straight Facts™.

Point phone camera here

According to the WSJ, the DOJ and HHS are looking into whether the healthcare conglomerate was billing the government based on inflated patient diagnoses, both inside and outside physician groups it owns. As of 2023, more than 90,000 physicians worked under UnitedHealthcare, representing nearly one in 10 U.S. doctors. The government pays private insurers a set rate to provide benefits to seniors beyond traditional Medicare coverage.

Some doctors have reportedly claimed that, through training and software, UnitedHealth encouraged them to document diagnoses that would result in higher profits for the company, regardless of whether those diagnoses were accurate or not.

In a statement, UnitedHealth Group, the parent company of UnitedHealthcare, accused the WSJ of reporting “misinformation” about its partnership with Medicare Advantage, adding that the company “consistently perform[s] at the industry’s highest levels” when reviewed by the government.

The statement goes on to say that the WSJ’s reporting amounts to a “year-long campaign to defend the legacy system that rewards volume over keeping patients healthy and addressing their underlying conditions,” calling the Journal’s allegations “outrageous and false.”

Get up to speed on the stories leading the day every weekday morning. Sign up for the newsletter today!

Learn more about our emails. Unsubscribe anytime.

Enter your email for newsletter updates Subscribe

By entering your email, you agree to the Terms & Conditions and acknowledge the Privacy Policy.

This DOJ investigation is just the latest in a series of scandals that have dogged UnitedHealth Group.

UnitedHealthcare was thrust into the spotlight in December after its CEO, Brian Thompson, was shot and killed while in New York to attend an annual UnitedHealth Group investors meeting. The company, which deals in health insurance, health technology, pharmacy benefits and physician practices, is one of the world’s largest corporations with a $457 billion market cap.

Also last year, a UnitedHealth Group technology company, Change Healthcare, suffered a data breach that exposed upwards of 85 million patient records. The company hosts roughly one-third of all payments made by insurers to providers.

More recently, CNBC reported that UnitedHealthcare is offering some employees in its benefits division a buyout option. If the company does not reach its workforce reduction goal through the buyouts –– which are available until March 3 –– it will begin laying off employees. UnitedHealth Group employed more than 440,00 people across its entire network of companies as of December 2023.