HealthExec February 21, 2025
The U.S. Department of Justice (DOJ) is investigating potential illegal activity at UnitedHealth Group, related to the insurer’s billing practices, according to a report published Friday by the Wall Street Journal.
Per the outlet, UnitedHealth is being probed for upcoding Medicare Advantage claims. Specifically, the DOJ is looking into whether the insurer is responsible for billing the Centers for Medicare & Medicaid Services (CMS) for diagnoses and treatments not applicable to the actual care a patient received.
For its coverage, the Wall Street Journal cites sources familiar with the case. According to reporters, the DOJ has spoken with providers about the alleged upcoding, which could have led to the insurer pocketing billions of extra reimbursement dollars.
The Wall...
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