The Brief
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UnitedHealth Group is under two DOJ investigations for alleged Medicare fraud.
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The probes focus on manipulating “diagnosis codes” to boost payments.
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The company stated it is cooperating and has launched its own review of practices.
DALLAS – More than 27 million Americans and nearly five million Texans receive their health insurance through UnitedHealth Group.
The insurance giant admitted it is under at least two DOJ investigations for allegedly defrauding the federal taxpayer-funded Medicare program.
FILE – The U.S. Department of Justice seal on a podium in Washington, D.C.
(Samuel Corum/Bloomberg via Getty Images)
For the first time, publicly, UnitedHealth Group acknowledged through a statement to FOX 4 the company: “Has now begun complying with formal criminal and civil requests from the department.”
The Wall Street Journal first reported the DOJ investigations months ago. One into the healthcare conglomerate’s Medicare billing practices, then a second, civil fraud probe into how United allegedly manipulated “diagnosis codes” to make more cash.
Dr. Bill Hennessey is not only a medical doctor, but also a staunch patient advocate. Hennessey says this investigation could be wide-reaching, looking back over United’s records from the last 10 years.
What they’re saying
“It’s this simple: the illegal return on investment is more than the legal return on investment. Go ahead and do what you have to and make the most money for your shareholders and your insurance company CEOs,” Hennessey said.
According to Hennessey, the whole system is rife with fraud.
“Everybody knows there are billing shenanigans, and we’re overpaying for care when it comes to the Big Four: Blue Shield, United, Cigna and Aetna,” Hennessey said.
In May, the DOJ accused Aetna, Humana and then-Anthem of working with insurance brokers to receive illegal kickbacks, involving Medicare advantage plans.
They have all denied those allegations.
It’s been a turbulent period for United Healthcare after its CEO Brian Thompson was shot and killed while entering a New York hotel in December 2024.
The company has been under increased scrutiny as it has tried to move forward. Though, despite the accusations, UnitedHealth Group says it: “Has a long record of responsible conduct and effective compliance.”
Adding, as these federal investigations play out, the company has proactively launched its own initiative to conduct third-party reviews of policies and practices.
What’s next
UnitedHealth Group’s financial forecast shows revenue in 2025 is projected at $450 to $455 billion dollars.
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