- According to the Wall Street Journal, DOJ has launched a civil fraud investigation into UnitedHealthcare over claims practices within the Medicare Advantage program. The study focuses on whether medical giants artificially inflate patient diagnosis and increase monthly payments from the government.
- In a statement, the UnitedHealth Group called it a report by the “Rutrageous and False” journal, and denounced the outlet for reporting “misinformation” about its partnership with Medicare Advantage.
- The investigation is the latest in a string of scandals that have defeated the healthcare giant since last year.
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UnitedHealthcare is currently under investigation by the US Department of Justice (DOJ). Recent reports from the Wall Street Journal. The government has used patient diagnosis to consider whether the Medicare Advantage program illegally inflates monthly payments received and has launched a civil fraud investigation.
Medicare Advantage is a division of Medicare, a public health insurance program that serves more than 65 million seniors and Americans with disabilities. According to the US Department of Health and Human Services (HHS), Medicare Advantage enrolled approximately 25% in 2010. By 2024, that number had risen Up to 54%, according to KFF, a non-profit health policy research firm.
The UnitedHealthcare investigation is led by the DOJ's private fraud division and the HHS Inspector General's Office.
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According to the WSJ, DOJ and HHS are considering whether healthcare conglomerates are billing the government based on inflated patient diagnosis, both within and outside the group of physicians they own. As of 2023, Over 90,000 doctors worked under UnitedHealthcarerepresenting one in ten US doctors. The government pays private insurance companies the fees set to provide benefits to seniors beyond traditional Medicare coverage.
Some doctors argue that through training and software, UnitedHealth has encouraged them to document company profitable diagnosis, regardless of whether those diagnoses are accurate or not.
In a statement, UnitedHealth Group, the parent company of UnitedHealthCare, accused WSJ of reporting “misinformation” about its partnership with Medicare Advantage, adding that the company “is consistently performing.”[s] At the highest level of the industry when reviewed by the government.”
The statement added that the WSJ report “a one-year campaign to defend a legacy system that rewards quantities for keeping patients healthy and addressing underlying conditions,” as well as the Journal allegations. “We will deal with outrageously incorrect conditions.”
This DOJ investigation is just the latest in a series of scandals that dogged the UnitedHealth Group.
UnitedHealthcare was in the spotlight in December after CEO Brian Thompson was shot dead in New York to attend the annual UnitedHealth Group Investors Meeting. Handling health insurance, health technology, pharmacy benefits and physician practices, the company is one of the world's largest companies with a market capitalization of $457 billion.
Also last year, UnitedHealth Group Technology Company's Change Healthcare suffered a data breaches that revealed patient records of over 85 million people. The company hosts about a third of all payments that the insurance company has made to its provider.
recently, CNBC reported UnitedHealthCare offers acquisition options to some employees in its benefits division. If the company has not reached its workforce reduction target through buyouts available until March 3, it will begin laying off employees. As of December 2023, UnitedHealth Group employed more than 440,000 people across its corporate network.
