UnitedHealth Faces Broader Justice Department Probe Beyond Medicare Fraud

The Justice Department's criminal division is investigating UnitedHealth Group's pharmacy benefit manager Optum Rx and its reimbursement practices for its own doctors, in addition to potential Medicare fraud. The probe is broader than previously known and the company has not been accused of wrongdoing. UnitedHealth Group has full confidence in its practices and is responding to civil and criminal Justice Department probes.

The U.S. Justice Department’s criminal division has expanded its investigation into UnitedHealth Group Inc., scrutinizing the company’s pharmacy benefit manager, Optum Rx, and its reimbursement practices for its own doctors. This broader probe goes beyond the previously known Medicare fraud inquiry, according to sources familiar with the matter [1].

The Justice Department is examining business practices at Optum Rx, which is one of the top three pharmacy benefit managers in the U.S. and dispenses drugs through mail-order and specialty pharmacies. The probe also includes an investigation into how UnitedHealth reimburses its own doctors. This expanded scope adds complexity to the ongoing criminal investigation into UnitedHealth’s Medicare Advantage billing practices, which has been ongoing since at least last summer [2].

UnitedHealth has not been accused of wrongdoing by the Justice Department. The company has stated it has "full confidence in its practices" and is responding to both civil and criminal probes [1]. The company has also faced a separate civil fraud investigation into its Medicare billing practices and a lawsuit from the Federal Trade Commission over potential antitrust issues and insulin pricing [3].

UnitedHealth shares have been volatile in recent months. The company has faced several challenges, including a civil Medicare fraud case, a lawsuit from the FTC, and the resignation of its CEO, Andrew Witty, in May. The company’s shares have lost about 40% this year through Monday’s close [1].

The broader probe may complicate matters for UnitedHealth, but the company has taken steps to address regulatory and reputational risks. In August, UnitedHealth announced a new committee of its board to increase oversight of these issues. The committee’s charter highlights the company’s pharmacy benefits management practices as a key reputational risk [1].

References:
[1] https://www.bloomberg.com/news/articles/2025-08-26/unitedhealth-ongoing-criminal-probe-is-broader-than-medicare
[2] https://ca.finance.yahoo.com/news/unitedhealth-stock-ticks-lower-amid-203408482.html
[3] https://www.benzinga.com/trading-ideas/movers/25/08/47345886/unitedhealth-stock-falls-as-department-of-justice-criminal-probe-expands-to-optum-rx-report