UnitedHealth Engages DOJ in Medicare Advantage Investigation

UnitedHealth Group has initiated voluntary contact with the U.S. Department of Justice (DOJ) following media reports about investigations into its Medicare Advantage program practices.

The company has started cooperating with formal DOJ criminal and civil inquiries while maintaining confidence in the compliance and integrity of its operations. Independent audits by the Centers for Medicare & Medicaid Services (CMS) have previously affirmed UnitedHealth’s accuracy and compliance, and a court-appointed Special Master found no wrongdoing after a prolonged civil challenge on certain Medicare Advantage business aspects. 

Additionally, UnitedHealth has launched third-party reviews on risk adjustment coding, managed care practices, and pharmacy services to ensure adherence to regulatory standards and internal policies. Earlier this year, The Wall Street Journal reported that federal investigators were examining the company’s diagnosis recording processes that impact payment adjustments within Medicare Advantage plans.

UnitedHealthcare, the company’s insurance division, serves over 8 million members, making it the largest provider in this market segment. This investigation reflects ongoing scrutiny of Medicare Advantage payment and coding methodologies, which are crucial for regulatory compliance and financial integrity within the payer industry.