“My office has been hearing from folks across the Hudson Valley about a decline in care, especially at CareMount Medical and Crystal Run Healthcare, following their purchase by Optum,” Rep. Pat Ryan of New York wrote in a Feb. 26 news release. “I’m launching this community inquiry to hear from as many folks as possible to directly inform my ongoing oversight. Whether it’s inaccurate billing, new or increased fees, or difficulty getting appointments, it’s unacceptable for any corporation to be driving down quality and driving up costs.”
Mr. Ryan specifically referenced reports alleging that UnitedHealthcare may be compensating Optum practices at higher rates in an effort to undercut local competitors, as well as improperly inflating member diagnosis codes to maximize reimbursements from Medicare.
In 2022, Optum purchased CareMount Medical, a medical group with over 2,100 providers. In 2023, the company purchased Crystal Run Healthcare, with about 400 providers.
“Since these practices chose to join Optum, we have introduced a number of new measures to continue to enhance our services, including dedicated teams responsible for scheduling and supporting medication refills and clinical questions, as well as technology investments to improve our patients’ experiences,” an Optum spokesperson told Becker’s. “We, too, have felt the impact of the national health care provider shortage and are continuing to invest in solutions to attract, support and retain our dedicated care providers. We look forward to meeting with policymakers to discuss the ways in which we can all work together to achieve our common goal of providing the highest quality patient care for individuals and families we are privileged to serve.”
The New York probe follows an inquiry by Senator Chuck Grassley into UnitedHealth’s Medicare Advantage billing practices following a report from The Wall Street Journal stating the company is being investigated by the U.S. Department of Justice for fraudulently inflating diagnosis codes — UnitedHealth has denied that the DOJ has opened an investigation into its billing practices.
The billing probe would mark the second active DOJ investigation into UnitedHealth, following a 2024 investigation that is examining the relationship between UnitedHealthcare and Optum.
