Medical Economics July 24, 2025
Key Takeaways
- UnitedHealth is cooperating with DOJ investigations into its Medicare Advantage billing practices, focusing on diagnoses that increased federal payments.
- Allegations include inflated risk scores and diagnoses added without physician confirmation, raising questions of potential fraud.
- UnitedHealth has launched an internal review and maintains confidence in its compliance and documentation practices.
- The company’s stock has declined amid these challenges, and broader implications for Medicare Advantage and private insurers are anticipated.
Federal civil and criminal probes target diagnosis coding in Medicare Advantage plans as insurer launches internal review.
UnitedHealth Group, the nation’s largest health insurer, disclosed Thursday that it is cooperating with a criminal and civil investigation by the U.S. Department of Justice (DOJ) into its Medicare billing...
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