UnitedHealth Group is complying with criminal and civil investigations into its Medicare Advantage business, the company said in a July 24 regulatory filing.
The disclosure comes after The Wall Street Journal reported in May that the Justice Department has been investigating allegations of Medicare Advantage fraud. In May, the company said it had not been notified about any investigation by the Justice Department.
In the new regulatory filing, UnitedHealth said it “proactively reached out to the Department of Justice after reviewing media reports about investigations into certain aspects of the company’s participation in the Medicare program.”
“The Company has now begun complying with formal criminal and civil requests from the Department,” UnitedHealth said.
Here are five things to know:
- In July, former UnitedHealthcare employees told The Wall Street Journal investigators had questioned them about the company’s Medicare Advantage billing and coding practices. The investigation has been ongoing since at least 2024, according to the Journal.
- 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. The Journal reports that UnitedHealth Group received $8.7 billion in payments from the federal government in 2021 for diagnoses not documented in treatment claims from members.
- In its July 24 statement, UnitedHealth Group said CMS audits “confirm the company’s practices are among the most accurate in the industry.”
In March, a special court master recommended that a more than decade-old DOJ lawsuit against UnitedHealth be thrown out, which alleges the company overcharged the federal government through MA claims. - UnitedHealth has launched an initiative to conduct third-party reviews of its risk assessment coding, managed care and pharmacy practices, according to the statement. CEO and board chair Stephen Hemsley said in June that independent experts will evaluate and assess the reviews and will modify strategies if appropriate.
- UnitedHealthcare is the nation’s largest Medicare Advantage insurer, with 8.2 million members.
The investigation is one of several major challenges the company has faced in the past two years. In May, UnitedHealth Group pulled its earnings guidance for 2025, citing rising medical costs. The company also replaced former CEO Andrew Witty, bringing in Mr. Hemsley, who led the company from 2006 to 2017, back to the top spot.
UnitedHealth Group has faced heightened scrutiny of its business practices following the targeted killing of former UnitedHealthcare CEO Brian Thompson in late 2024, along with the crippling cyberattack on subsidiary Change Healthcare.
