UnitedHealth Group leveraged “aggressive strategies” to secure higher-paying Medicare Advantage diagnoses, according to a Jan. 12 Senate report.
The Wall Street Journal initially covered the news. Senate Judiciary Chair Chuck Grassley, R-Iowa, started an investigation into the insurer’s billing and coding practices — reviewing 50,000 pages of documents — in February, following earlier WSJ reporting. The Journal identified $8.7 billion in 2021 payments from the federal government for insurer-added diagnoses. UnitedHealth said WSJ reporting was based on “incomplete and inaccurate” insights. Criminal and civil investigations from the Justice Department are also ongoing, focused on similar issues and Optum Rx physician compensation. UnitedHealth previously confirmed its cooperation with investigators.
While the report does not make recommendations or accuse UnitedHealth of misconduct, it does point out how nurses collected diagnoses at patient homes, doctors received bonuses for weighing other diagnoses and AI was used to search for new diagnoses in patient records.
“Bloated federal spending to UnitedHealth Group is not only hurting the Medicare Advantage program, it’s harming the American taxpayer,” Mr. Grassley said in a news release.
Examples of concerning diagnoses included atrial fibrillation, chronic obstructive pulmonary disease, diabetic cataracts and opioid dependence. UnitedHealth had nurse practitioners visiting patient homes in its HouseCalls program to test patients for peripheral artery disease using the QuantaFlo device.
However, according to the WSJ, a Senate Judiciary Committee staff member said a UnitedHealth lawyer emailed last week saying the company stopped using the QuantaFlo device after adjustments in Medicare rules. UnitedHealth’s share price dipped in the wake of a federal risk-adjustment overhaul, but the company modified its peripheral artery screenings to boost efficiency, the article said.
“We regularly engage with CMS, the committee and others on ways to improve programs that keep seniors healthier and more independent and look forward to continuing to work together. We do, however, disagree with the committee’s characterizations of our Medicare Advantage coding practices and HouseCalls program,” a UnitedHealth spokesperson said in a statement shared with Becker’s Jan. 12. “Our programs comply with applicable CMS requirements and have, through government audits, demonstrated sustained adherence to regulatory standards. Our programs are subject to rigorous clinical quality controls and compliance safeguards. We are proud of the compassionate care our HouseCalls clinicians deliver to seniors every day. We remain focused on continuing to deliver lower costs, better access and higher quality care for the people we serve, including those in Medicare Advantage.”
UnitedHealth also shared recent studies to highlight Medicare Advantage savings for the federal government.
The update comes as senators expand a separate probe into UnitedHealth’s nursing home practices.
