UnitedHealth Group Faces DOJ Medicare Fraud Probe Amid Leadership Changes

UnitedHealth Group, the largest provider of Medicare Advantage plans in the U.S., is reportedly under a criminal investigation by the Department of Justice (DOJ) for potential Medicare fraud, according to anonymous sources cited by The Wall Street Journal.

The investigation, led by the DOJ's health care fraud unit, has reportedly been ongoing since at least last summer. UnitedHealth has stated that it has not received any official notification of an investigation and maintains the integrity of its Medicare Advantage program.

The inquiry adds to multiple existing government investigations into UnitedHealth, including potential antitrust issues and a civil probe into its Medicare billing practices. The civil case, which involves allegations that UnitedHealth submitted inaccurate diagnoses for payment amounting to $2 billion, has faced judicial scrutiny with a court-appointed special master recommending dismissal due to insufficient evidence.

The company's leadership has recently seen changes with CEO Andrew Witty stepping down and chairman Stephen Hemsley taking over, amid other challenges including cybersecurity incidents and rising medical costs that led to the suspension of UnitedHealth's 2025 financial outlook.

The reported DOJ probe highlights ongoing regulatory and compliance scrutiny on Medicare Advantage programs and the broader health insurer landscape. While the exact nature of any potential criminal allegations remains unclear, the case underscores the complex oversight environment insurers face regarding government reimbursement programs and billing practices.