WSJ: Former UnitedHealth employees questioned in DOJ investigation

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Justice Department officials have questioned former UnitedHealth Group employees as part of an investigation into the company’s Medicare Advantage billing practices, The Wall Street Journal reported July 9. 

The Journal first reported in May that the company was under criminal investigation for alleged Medicare Advantage fraud. The investigation has been ongoing since 2024, according to the report

Former physician employees of UnitedHealth Group told the Journal that investigators questioned them about Medicare Advantage coding and diagnosis practices. Prosecutors from the Justice Department’s healthcare fraud unit are conducting the investigations, with the Federal Bureau of Investigation and HHS’ Office of Inspector General also participating in some of the interviews. 

Nearly every major payer has been accused of, or settled allegations of upcoding — the fraudulent billing practice of making patients appear sicker on paper to receive higher reimbursement from the federal government. CMS has said it will begin auditing every Medicare Advantage plan every year for potential upcoding. 

The Journal reports that UnitedHealth Group received $8.7 billion in 2021 for diagnoses not documented in treatment claims from members. 

In a July 9 statement, UnitedHealth Group said it stands behind the integrity of its Medicare Advantage program. 

“Today’s article from The Wall Street Journal represents a continuation of its sustained campaign against Medicare Advantage, relying on incomplete data, a predetermined narrative and a flawed understanding of how the Medicare Advantage program works,” the company said. 

The payer went on to say it is “among the most accurate in the industry in [its] coding practices.”

In March, a special master recommended throwing out a more than a decade-old lawsuit against UnitedHealth Group which alleged the company engaged in Medicare Advantage fraud. A judge has yet to make a final decision as to whether the case can continue. 

“After more than a decade of a similar Department of Justice challenge to our Medicare Advantage business, the Special Master concluded there was no evidence to support the claims that we were overpaid or engaged in any wrongdoing,” UnitedHealth Group said. 

Read the Journal’s full report here

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