WSJ: DOJ Investigates Medicare Billing Practices at UnitedHealth

[Dennis Donovan]

WSJ - (archived: https://archive.ph/WxdYy ) DOJ Investigates Medicare Billing Practices at UnitedHealth

Civil probe of diagnoses that triggered extra payments to the company’s Medicare Advantage plans adds to scrutiny of the healthcare giant

By Christopher Weaver and
Anna Wilde Mathews
Feb. 21, 2025 7:00 am ET

The Justice Department has launched an investigation into UnitedHealth Group’s Medicare billing practices in recent months, people familiar with the matter say.

The new civil fraud investigation is examining the company’s practices for recording diagnoses that trigger extra payments to its Medicare Advantage plans, including at physician groups the insurance giant owns.

A series of articles in The Wall Street Journal last year showed that Medicare paid UnitedHealth billions of dollars for questionable diagnoses. Attorneys with the Justice Department as recently as Jan. 31 interviewed medical providers named in the articles.

In the Medicare Advantage system, insurers get lump-sum payments from the federal government to oversee enrollees’ Medicare benefits. When patients have certain diagnoses, the payments go up, creating an incentive to diagnose more diseases.

The Medicare billing investigation adds to the scrutiny on UnitedHealth, the $400 billion company that owns the largest U.S. health insurer and a sprawling network of other health-industry assets including its doctor practices, a large pharmacy-benefit manager and data and technology operations.

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