The US Department of Justice is reportedly investigating insurance giant UnitedHealthcare for Medicare claims practices.
According to a report in the Wall Street Journal, the federal government is looking into whether UnitedHealthCare is using patient diagnosis to illegally increase lump sums received through the Medicare Advantage program.
Although it is best known for its insurance operations, UnitedHealthcare is one of the largest companies in the world with a market capitalization of $457 billion. The business touches on health technology, the benefits of pharmacies, and doctor practices.
Because the company is so large, analysts in one industry estimate that 5% of the total US product flows through infrastructure every day. It has the largest physician employer in the United States with over 90,000 doctors in 2023, or one in ten American doctors.
The Justice Department is currently conducting a civil fraud investigation, according to the report.
Medicare is a public health insurance program for the elderly and disabled, covering more than 65 million Americans. Approximately half of these beneficiaries use the Medicare Advantage plan. This is a program launched by Congress to allow private insurers to manage the care of their beneficiaries.
When it was created during the George W. Bush administration, supporters argued that private companies could provide the same services as the government more efficiently and save taxpayers money.
But now, many studies show that the program probably costs billions more every year. A survey by the Medicare Payment Advisory Committee (MEDPAC) found that in 2024 alone, the Medicare Advantage Plan costs taxpayers $830 billion (22%) more than traditional Medicare.
Additionally, more and more patients are complaining about how programs make access to care difficult, for example, by asking patients for permission or “pre-certification” from pre-treatment insurance companies. Masu.
The UnitedHealthcare investigation is being carried out by the Department of Justice’s Department of Civil Fraud and the Department of Health and Human Services, the Journal reported. The investigation is separate from the ongoing Department of Justice antitrust investigation.
In a statement in response to the journal’s report, UnitedHealthGroup stated: The government regularly plans to ensure all (Medicare Advantage) compliance and we consistently perform at the highest level in the industry in these reviews. ”
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The statement continued: “We are not aware of the “start” of “new” activities reported in the journal. However, the journal recognizes it is engaged in a year-long campaign to advocate for a legacy system that keeps patients healthy and rewards quantities for dealing with underlying conditions. The suggestion that our practice is fraud is outrageous and wrong. ”
The huge company is also being scrutinized for other parts of its business. UnitedHealth Group owns Change Healthcare, a technology company that promotes a third of all payments from insurers to providers. A major data breaches in 2024 allowed hackers to “remove” 85m patient records. The event was described by one analyst as a “Deep Water Horizon Moment” for healthcare.
The murder of United Healthcare CEO Brian Thompson has brought more scrutiny to the company. The murder of an executive, described as a kind family man, encountered indifference and riss from the American public who described daily refusing to medical care.
UnitedHealth shares fell 10% on early morning news.
