UnitedHealth Group is complying with criminal and civil investigations by the Justice Department regarding its Medicare Advantage business, according to a July 24 regulatory filing by the company.
Here are 7 things to know about the investigation into the nation’s largest Medicare Advantage insurer:
1. The disclosure by UnitedHealth comes after The Wall Street Journal reported in May that the Justice Department was investigating allegations of MA fraud. At that time, UnitedHealth said it had not been notified about any investigation by the Justice Department.
2. In the new regulatory filing, UnitedHealth said it “proactively reached out to the Department of Justice after reviewing media reports about investigations into certain aspects of the company’s participation in the Medicare program.”
“The Company has now begun complying with formal criminal and civil requests from the Department,” UnitedHealth said in the filing.
3. In July, former employees of UnitedHealth told the Journal that investigators had questioned them about MA billing and coding practices.
4. The Journal reported that UnitedHealth Group received $8.7 billion in payments from the federal government in 2021 for diagnoses not documented in treatment claims from members.
5. In the new regulatory filings, UnitedHealth Group said its company’s practices are among the most accurate in the industry, which it claims can be confirmed by CMS audits.
6. CEO and board chair Stephen Hemsley said in June that independent experts would evaluate and assess third-party reviews of its risk assessment coding, managed care and pharmacy practices as a part of a new initiative. He said that the company would modify its strategies if deemed appropriate.
7. In March, a special court master recommended that a more than decade-old DOJ lawsuit against UnitedHealth be thrown out, which alleges the company overcharged the federal government through MA claims.
