UnitedHealth Group confirmed Thursday that it is under investigation by the U.S. Department of Justice (DOJ) over its Medicare billing practices, marking another chapter in mounting federal scrutiny of the healthcare giant’s operations.
The disclosure follows a Wall Street Journal report in May revealing that the DOJ had launched a criminal investigation into possible Medicare fraud involving the company’s Medicare Advantage program. At that time, UnitedHealth defended its position, stating it “stands by the integrity of our Medicare Advantage program.”
In July, further reporting by the Journal indicated that federal investigators had interviewed multiple physicians, probing whether they were pressured by UnitedHealth to submit diagnosis codes that may have inflated the company’s payments under the Medicare Advantage program.
This criminal inquiry is the second major DOJ probe targeting UnitedHealth’s Medicare Advantage business this year. In February, the Journal reported that the DOJ was also conducting a civil investigation into whether the company intentionally exaggerated patient diagnoses to secure higher reimbursements from Medicare.
In a related development, UnitedHealth had appeared to make progress in resolving a separate, long-running legal case stemming from a whistleblower complaint that alleged the company wrongfully retained at least $2 billion in Medicare payments. In March, a court-appointed special master recommended dismissal of the case, citing insufficient evidence from the DOJ to support the allegations.
UnitedHealth’s Medicare and Retirement segment — which includes its Medicare Advantage business — is its largest revenue generator, bringing in $139 billion in sales last year alone.
The investigation caps a turbulent period for the company. Shares of UnitedHealth Group have plummeted over 42% year-to-date. The company has faced a wave of challenges in 2024, including rising medical expenses, a surprise leadership shakeup following CEO Andrew Witty’s resignation, and reputational fallout from an ongoing federal probe into its Medicare practices.
Adding to the turmoil, the company endured a massive cyberattack this year and continued public backlash after the shocking murder of UnitedHealthcare CEO Brian Thompson.
Despite these setbacks, UnitedHealth remains one of the most influential players in the U.S. healthcare system, and the outcome of the DOJ investigations could carry significant implications for Medicare Advantage oversight and reimbursement practices across the industry.
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