UnitedHealth Group Faces DOJ Probe Over Medicare Operations

UnitedHealth Group (UNH.US) has confirmed that it is under investigation by the U.S. Department of Justice (DOJ) regarding its Medicare operations. The company disclosed this information in a filing on Thursday, acknowledging the ongoing criminal and civil probes that have been rumored for the past two years. UnitedHealth Group stated that it is fully cooperating with the investigation and emphasized its long-standing commitment to responsible business practices and a strong record of compliance.

This latest development adds to the challenges faced by the healthcare giant, which has recently undergone a leadership change and withdrawn its performance guidance. The company has been the subject of multiple DOJ investigations in recent years, including an antitrust probe in 2024 and an investigation into its Medicare Advantage business that began as early as last summer.

UnitedHealth Group has consistently maintained the integrity of its Medicare Advantage operations. However, the program has long been under scrutiny due to allegations that some insurance companies inflate patient diagnoses to increase reimbursements. The reimbursement levels are determined by the diagnostic codes reported by the companies. Regulatory bodies and whistleblowers have accused several firms of exaggerating patient conditions to boost profits, leading to substantial settlements in past cases.

The Medicare Advantage program allows insurance companies to provide services to patients with more severe conditions, for which they receive higher payments. The program's complexity and the potential for abuse have made it a focal point for regulatory scrutiny. UnitedHealth Group's confirmation of the DOJ investigation highlights the ongoing challenges faced by the healthcare industry in ensuring compliance and transparency in its operations.