UnitedHealth faces DOJ investigation after fraud accusations

UnitedHealth Group is complying with a federal investigation following allegations of inappropriate Medicare billing practices, according to an 8-K filing with the Securities and Exchange Commission.

Per the filing, UnitedHealth initiated contact with the Department of Justice (DOJ) "after reviewing media reports about investigations into certain aspects of the Company's participation in the Medicare program."

The DOJ probe follows reporting from The Wall Street Journal indicating that UnitedHealth was under investigation for how it records diagnoses that could lead to extra payments in its Medicare Advantage plans. The Journal also reported earlier in the year that the DOJ was conducting an investigation into the insurer over possible Medicare fraud.

UnitedHealth denied wrongdoing as specified in the Journal's reporting, adding in July that the articles were "a continuation of its sustained campaign against Medicare Advantage, relying on incomplete data, a predetermined narrative and a flawed understanding of how the Medicare Advantage program works."

UnitedHealth maintained in the new 8-K filing that its "practices are among the most accurate in the industry," as evidenced by independent CMS audits.

The company did not explicitly disclose the nature of the DOJ investigation but said it has launched its own initiative to review "policies, practices, and associated processes and performance metrics for risk assessment coding, managed care practices, and pharmacy services."

The company will use third-party reviews to conduct its internal investigation.

Still, UnitedHealth "has full confidence in its practices and is committed to working cooperatively with the Department throughout this process," according to the filing.

This news comes in the middle of a tumultuous year for UnitedHealth. At the end of 2024, UnitedHealthcare CEO Brian Thompson was fatally shot while commuting to the company's annual investor meeting.

And, following a grim financial forecast due to higher-than-expected medical costs, CEO Andrew Witty stepped down for what the company termed as personal reasons. Witty was immediately replaced by Stephen J. Hemsley, who previously served as UnitedHealth CEO from 2006 to 2017.

Alongside Witty's exit was UnitedHealth's announcement that it would suspend its 2025 outlook, stating that healthcare access and care activity had increased more than previously anticipated.

UnitedHealth was also hit by a historic cyberattack in 2024 when hackers infiltrated Change Healthcare's systems, exposing the personal information of 190 million people.

Sara Heath has reported news related to patient engagement and health equity since 2015.

Jacqueline LaPointe is a graduate of Brandeis University and King's College London. She has been writing about healthcare finance and revenue cycle management since 2016.