UnitedHealth's DOJ Inquiry: A Closer Look at Medicare Billing Practices
UnitedHealth's Recent Challenges in Medicare Billing
On Thursday, UnitedHealth Group confirmed it is facing both criminal and civil investigations from the Department of Justice (DOJ) regarding its Medicare billing practices.
The health care giant stated in a securities filing that it has started to comply with formal requests from the DOJ. As a result, UnitedHealth's stock experienced a decline of nearly 4 percent.
Background of the Investigation
In its filing, UnitedHealth emphasized its long history of responsible conduct. The company referenced independent audits that confirm its practices are among the most accurate within the industry. Following an extensive civil challenge from the DOJ regarding aspects of its Medicare Advantage operations, a court-appointed Special Master concluded there was no evidence of wrongdoing.
Proactive Measures by UnitedHealth
- Initiatives to conduct third-party reviews of policies and practices.
- Focus on risk assessment coding and related processes.
- Following increased media scrutiny, UnitedHealth proactively reached out to the DOJ.
February reports indicated that the DOJ had launched a civil investigation into potential inflation of diagnoses for additional payments to Medicare Advantage plans, and details of a criminal probe surfaced in May.
Implications for UnitedHealth and the Market
The announcement, preceding the company's scheduled second-quarter earnings call on July 29, signals potential shifts in strategy under new CEO Stephen Hemsley, who assumed command in May. This year has seen UnitedHealth navigating challenging waters, including the suspension of its 2025 earnings forecast due to increased medical costs from new enrollees in Medicare Advantage plans.
This article was prepared using information from open sources in accordance with the principles of Ethical Policy. The editorial team is not responsible for absolute accuracy, as it relies on data from the sources referenced.