UnitedHealth under federal investigation—Civil fraud claims raise serious concerns
- Replies 1
If you’ve been following the headlines lately, you might have noticed a big name in health care—UnitedHealth Group—making waves for all the wrong reasons.
The company, which insures millions of Americans (including many of us in the over-60 crowd), has just revealed it’s under federal investigation for civil fraud.
But what does this mean for you, your health coverage, and the future of Medicare Advantage?
UnitedHealth Group, the nation’s largest provider of Medicare Advantage plans, announced it’s cooperating with a Department of Justice (DOJ) investigation. The company says it’s responding to both criminal and civil requests from federal investigators.
While UnitedHealth insists it has a “long record of responsible conduct and effective compliance,” the feds are taking a closer look at how the company has been running its Medicare Advantage business.
The investigation is serious enough that UnitedHealth had to disclose it to the Securities and Exchange Commission (SEC)—the government body that keeps an eye on publicly traded companies.
Earlier this year, The Wall Street Journal reported that federal officials had launched a civil fraud investigation into UnitedHealth’s Medicare Advantage practices. Specifically, investigators are looking at how the company records diagnoses for its Medicare Advantage (MA) plans.
Why does this matter? Because the way diagnoses are recorded can affect how much money UnitedHealth gets from the government for each patient.
Medicare Advantage plans are privately run versions of Medicare, mostly serving people 65 and older. The government pays insurers like UnitedHealth more for sicker patients, based on the diagnoses reported.
Read also: Is your medical data safe? Millions may be at risk after major hospital cyberattack
If a company “upcodes”—that is, exaggerates or misrepresents how sick patients are—it can collect more money than it should. That’s the heart of the civil fraud investigation.
If you’re one of the 8 million people covered by UnitedHealthcare’s Medicare Advantage plans, you might be wondering, “Is my coverage at risk?” The short answer is: not immediately.
Your benefits and coverage aren’t going to vanish overnight because of this investigation.
Read also: Could you be charged extra for Medicare without realizing it?
UnitedHealth says it’s cooperating fully with the investigation and that it reached out to the DOJ after seeing media reports about the probe.
The company maintains it has a strong record of compliance and responsible conduct. Still, the fact that they’re under investigation is enough to make investors nervous—UnitedHealth’s stock price dropped nearly 2% after the news broke.
It’s also worth noting that UnitedHealth has had a tough year. The company’s CEO, Brian Thompson, was tragically killed in December, and the business has been under pressure from rising health care costs and government rate cuts.
Read next: Bigger benefits, smaller payoff? Medicare costs may cut into your next Social Security raise
Have you had experiences (good or bad) with Medicare Advantage? Are you worried about how this investigation might affect your coverage? Do you have tips for navigating the sometimes-confusing world of health insurance?
The company, which insures millions of Americans (including many of us in the over-60 crowd), has just revealed it’s under federal investigation for civil fraud.
But what does this mean for you, your health coverage, and the future of Medicare Advantage?
UnitedHealth Group, the nation’s largest provider of Medicare Advantage plans, announced it’s cooperating with a Department of Justice (DOJ) investigation. The company says it’s responding to both criminal and civil requests from federal investigators.
While UnitedHealth insists it has a “long record of responsible conduct and effective compliance,” the feds are taking a closer look at how the company has been running its Medicare Advantage business.
The investigation is serious enough that UnitedHealth had to disclose it to the Securities and Exchange Commission (SEC)—the government body that keeps an eye on publicly traded companies.
Earlier this year, The Wall Street Journal reported that federal officials had launched a civil fraud investigation into UnitedHealth’s Medicare Advantage practices. Specifically, investigators are looking at how the company records diagnoses for its Medicare Advantage (MA) plans.
Why does this matter? Because the way diagnoses are recorded can affect how much money UnitedHealth gets from the government for each patient.
Medicare Advantage plans are privately run versions of Medicare, mostly serving people 65 and older. The government pays insurers like UnitedHealth more for sicker patients, based on the diagnoses reported.
Read also: Is your medical data safe? Millions may be at risk after major hospital cyberattack
If a company “upcodes”—that is, exaggerates or misrepresents how sick patients are—it can collect more money than it should. That’s the heart of the civil fraud investigation.
If you’re one of the 8 million people covered by UnitedHealthcare’s Medicare Advantage plans, you might be wondering, “Is my coverage at risk?” The short answer is: not immediately.
Your benefits and coverage aren’t going to vanish overnight because of this investigation.
Read also: Could you be charged extra for Medicare without realizing it?
UnitedHealth says it’s cooperating fully with the investigation and that it reached out to the DOJ after seeing media reports about the probe.
The company maintains it has a strong record of compliance and responsible conduct. Still, the fact that they’re under investigation is enough to make investors nervous—UnitedHealth’s stock price dropped nearly 2% after the news broke.
It’s also worth noting that UnitedHealth has had a tough year. The company’s CEO, Brian Thompson, was tragically killed in December, and the business has been under pressure from rising health care costs and government rate cuts.
Read next: Bigger benefits, smaller payoff? Medicare costs may cut into your next Social Security raise
