Additional Coverage:
The Department of Justice is investigating UnitedHealth Group’s Medicare billing practices. The investigation centers on how the company records diagnoses, which determine additional payments to its Medicare Advantage plans.
Sources say the DOJ is looking into whether UnitedHealth is improperly inflating diagnoses to increase payments. This follows a report revealing a significant rise in lucrative diagnoses for patients who enrolled in the company’s Medicare Advantage plans and were seen by UnitedHealth-employed doctors.
UnitedHealth denies any wrongdoing, calling the suggestions of fraud “outrageous and false.” The company insists it complies with regulations and performs at the highest industry standards.
Medicare is a federal insurance program primarily for people 65 and older. Medicare Advantage, also known as Medicare Part C, is offered by private companies like UnitedHealth Group as an alternative to traditional Medicare.
The DOJ investigation follows other recent scrutiny of UnitedHealth Group. The company has faced criticism for its claim denial rates, even before the December murder of CEO Brian Thompson.
A Senate subcommittee recently accused UnitedHealth of increasing claim denials while using artificial intelligence to automate the process. The company disputed these claims.
Additionally, the DOJ and several states filed a lawsuit to block UnitedHealth’s acquisition of Amedisys, a home health and hospice provider, citing concerns about patient care and competition. This latest investigation adds another layer of scrutiny to the company’s practices.