DOJ Launches Investigation into UnitedHealthcare

Civil fraud investigation launched because of reports that they over diagnose patients to get more medicare money...

According to a report published by the Wall Street Journal, the U.S. Justice Department is now investigating Unitehealth’s Medicare billing practices. The civil fraud investigation aims to examine how UnitedHealthcare records and diagnoses lead to extra payments for its Medicare Advantage plan.

Via PBS

Medicare Advantage Explained

About half of the 65 million people covered by Medicare are enrolled in Medicare Advantage plans operated by private insurers. Insurers receive a set rate for each patient, but they can get a bigger payout for patients with more than one health condition. This creates an incentive to diagnose more diseases to get a bigger payout.

In December, WSJ reported an analysis that billions of Medicare records showed patients monitored by UnitedHealth-employed doctors had a massive increase in “lucrative diagnoses” after joining UnitedHealthcare’s Medicare Advantage plans.

Aside from doctors saying that the company used software to suggest conditions and offered paid bonuses for considering the suggestions, they also said that they trained them to document “revenue-generating diagnoses” even if they felt ridiculous and irrelevant.

In 2021, UnitedHealth reportedly added diagnoses to patients’ records that no doctor treated, funneling an extra $8.7 billion in federal payments that year alone. The untreated diagnoses came from sources including in-home visits by nurses working for the company’s HouseCalls unit. Each UnitedHealth nurse visit was worth an additional $2,735 in average federal payments, per WSJ analysis of Medicare data from 2019-2021.

Former UnitedHealth nurse Practioner Valerie O’Meara even told the WSJ that DOJ attorneys were interested in the company software that suggested diagnoses and the role of her manager, who she claimed “urged” her to make new diagnoses beyond what the doctors had treated.

Never-ending greed…

UnitedHealth is a $400 billion company that owns the most prominent nation’s health insurer. They also have a booming network of other health-industry divisions, including doctor practices, a large pharmacy-benefit manager, and data/tech operations.

On top of this civil fraud investigation, they have another ongoing DOJ antitrust probe. The DOJ sued to block UnitedHealth's $3.3 billion acquisition of home-health company Amedisys based on antitrust grounds.

Having a UnitedHealth mega monopoly is the last thing we need right now.

Wrapping it up…

The ongoing civil fraud investigation into UnitedHealth’s Medicare billing practices highlights significant concerns over the company’s potential exploitation of the Medicare Advantage system for financial gain.

The investigation reveals troubling evidence of diagnoses being artificially inflated to secure larger federal payments, raising questions about the ethics of UnitedHealth's operations. With the company already under scrutiny for antitrust issues, this investigation underscores the need for tighter regulation and oversight to prevent monopolistic behavior and ensure that the Medicare system serves its intended purpose—providing quality care to those in need.