The Journal reported that the probing follows reports that the company inflated charges to maximize Medicare Advantage reimbursements. Citing unnamed sources familiar with the matter, the news outlet noted Feb. 21 that this investigation is separate from the DOJ’s ongoing antitrust probe into UnitedHealth, which began in 2024.
The Journal has previously published reports on insurers’ Medicare Advantage billing strategies, including UnitedHealth’s efforts to optimize government payments by increasing members’ documented sickness scores. According to one report, sickness scores for UnitedHealth patients transitioning from traditional Medicare rose by 55% in their first year in Medicare Advantage, compared to a 30% industry average, leading to higher reimbursements.
DOJ attorneys have interviewed healthcare providers named in these reports as recently as Jan. 31, the Journal noted, with interest in the software used by the insurer, diagnoses it promoted for employees to use with patients and incentive arrangements.
“The Wall Street Journal continues to report misinformation on the Medicare Advantage program,” UnitedHealth said in a statement Feb. 21. “The government regularly reviews all MA plans to ensure compliance and we consistently perform at the industry’s highest levels on those reviews. We are not aware of the ‘launch’ of any ‘new’ activity as reported by the Journal. We are aware, however, that the Journal has engaged in a year-long campaign to defend a legacy system that rewards volume over keeping patients healthy and addressing their underlying conditions. Any suggestion that our practices are fraudulent is outrageous and false.”
Medicare Advantage, which has grown from covering 19% of Medicare beneficiaries in 2007 to 54% in 2024, is the privatized version of Medicare that, while increasingly popular, faces serious scrutiny for waste and questionable practices. Nearly every major Medicare Advantage carrier has been accused of or settled allegations of upcoding going back years.
Most recently, a 2024 OIG audit revealed an estimated $7.5 billion in questionable risk-adjustments for 2023, while Senate findings indicate major insurers prioritized profits over patient care through aggressive prior authorization practices, often denying necessary post-acute care services to seniors.
The DOJ is investigating the relationship between UnitedHealthcare and Optum, while also suing to block the company’s planned $3.3 billion acquisition of home health provider Amedisys.
UnitedHealth is the country’s largest Medicare Advantage insurer at 7.8 million members as of Dec. 31. Its net earnings in 2024 were $14.4 billion, down 35.6% year over year. Amid financial pressures, the company is reportedly offering voluntary buyouts to some employees who agree to leave their positions by March 3.
