UnitedHealth has denied that the DOJ has opened an investigation into its billing practices.
On Feb. 24, Mr. Grassley penned a letter to UnitedHealth’s CEO, Andrew Witty, requesting detailed information by March 10 about the company’s MA billing practices, including the steps taken to review diagnosis codes, compliance audits, and the use of artificial intelligence in billing processes.
“Since 2015, I have pressed CMS and the DOJ to recover improper payments made to Medicare Advantage Organizations, including UnitedHealth Group,” Mr. Grassley wrote. “Despite these oversight efforts, MAOs continue to defraud the American taxpayer, costing them billions of dollars a year.”
The letter cited The Journal’s Feb. 21 report, along with an October audit report from HHS’ Office of Inspector General, which found that MA companies received an estimated $7.5 billion in payments in 2023 through home health risk assessments and chart reviews. UnitedHealth “stood out from its peers” in its use of home visits and chart reviews to generate payments, the OIG wrote, receiving $3.7 billion in risk-adjustment payments from HRAs and chart reviews in 2023.
“We welcome the opportunity to share the facts with Senator Grassley, especially given the ongoing misinformation campaign by the WSJ,” UnitedHealth said in a statement shared with Becker’s. “Medicare Advantage plans are doing exactly what the program was designed to do: meet the government’s objective of delivering better health outcomes and lower costs for seniors and Medicare overall. The MA program is highly regulated by the federal government, MA plans are regularly audited for accuracy and compliance, and we consistently perform at the industry’s highest levels. We have advocated that CMS conduct audits for every plan, every year, and remain supportive of that proposal. We hold ourselves to the highest ethical standards of quality and integrity in our practices.”
In its report, The Journal cited unnamed sources familiar with the matter. The outlet noted that the latest investigation is separate from the DOJ’s ongoing antitrust probe into UnitedHealth, which began in 2024 and is probing the relationship between UnitedHealthcare and Optum.
The Journal has previously published reports on insurers’ Medicare Advantage billing strategies. 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.
Medicare Advantage provided health coverage to 54% of older adults in 2024. Nearly every major carrier has been accused of or settled allegations of upcoding going back years. UnitedHealth is the country’s largest MA insurer, at 7.8 million members as of Dec. 31.