UnitedHealth Cooperates with Federal Investigations of Medicare Advantage Practices

UnitedHealth Group has confirmed its cooperation with ongoing federal criminal and civil investigations into its Medicare Advantage business. The company proactively informed the Department of Justice after media reports surfaced regarding probes into its billing practices, specifically how diagnoses are recorded to secure additional payments for Medicare Advantage plans.

These privately managed plans represent a substantial part of government Medicare programs, primarily serving individuals aged 65 and older. UnitedHealthcare, the group’s health insurance division, is the largest provider of Medicare Advantage plans, covering over 8 million enrollees. The division has faced financial pressure recently, attributed to increased healthcare utilization and reduced payment rates. Investigations reportedly center on practices involving the use of healthcare professionals to obtain diagnoses that could augment payments, with both civil fraud and criminal healthcare fraud units engaged.

UnitedHealth has expressed confidence in its compliance and record-keeping, committing to cooperate fully with authorities. The company operates a diversified portfolio beyond insurance, including a pharmacy benefits management segment and the Optum business, which focuses on care and technology services.

UnitedHealth recorded over $400 billion in revenue last year, ranking third in the Fortune 500 list. The company’s stock has declined significantly since reaching a peak in late 2024, impacted by leadership upheaval following the death of its CEO and subsequent financial guidance revisions citing higher-than-expected medical costs from Medicare Advantage members. Investors await the company’s upcoming second-quarter earnings report for further insights on performance and outlook.