DOJ Investigates UnitedHealth Group for Alleged Medicare Advantage Billing Fraud

While Luigi Mangione today stands trial for the killing of UnitedHealthcare CEO Brian Thompson, the U.S. Justice Department is launching a civil fraud investigation into the conglomerate’s Medicare billing practices. The probe evaluates whether UnitedHealth’s system accurately records diagnoses, The Wall Street Journal reports, especially as some lead to higher revenue for the company. UnitedHealth is a $400 billion corporation that owns the largest U.S. health insurer, United Healthcare, along with a number of other health-related services. The DOJ’s scrutiny surrounds its practices' recording diagnoses, which trigger payments to its Medicare Advantage plans.

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.

The Department of Justice has reportedly launched an investigation into UnitedHealth Group’s Medicare billing practices as scrutiny over the health insurance industry intensifies — sending the company’s stock plummeting. The probe is analyzing the company’s practice of frequently logging diagnoses that trigger larger payments to its Medicare Advantage plans, according to The Wall Street Journal. UnitedHealth shares plunged nearly 9% Friday. A series of Wall Street Journal reports last year found that Medicare paid UnitedHealth billions of dollars for questionable diagnoses.

Department of Justice investigating UnitedHealth's Medicare billing processes, Wall Street Journal reports. Shares of other health insurers such as Humana and CVS Health also fell between 3 percent and 4 percent in early trading. UnitedHealth said the report contained “misinformation” about its Medicare Advantage plans.

The Wall Street Journal says it's not aware of any new activity by the U.S. Department of Health and Human Services. The report says the agency is looking at the use of diagnosis data to trigger extra payments to the company’s Medicare Advantage plans. The company says it has no plans to change its billing practices.