A PROBE OF UNITEDHEALTH'S MEDICARE BILLING PRACTICES

The Justice Department has launched an investigation into UnitedHealth Group.

This fraud investigation looks into the company’s practices of adding extra diagnoses to patients’ records, sometimes for conditions that no doctor treated, in order to receive larger payouts. In a series of articles last year, the Wall Street Journal revealed that Medicare paid UnitedHealth billions of dollars for questionable diagnoses.

In addition, a recent report from a Senate committee investigation has found that UnitedHealth is gaming the system to inflate its reimbursement from the federal government for Medicare Advantage plans. The findings are based on a review of more than 50,000 records shared with the Senate Judiciary Committee. Among other things, UnitedHealth incentivized doctors to assess for particularly lucrative conditions in order to maximize profit.

Most major Medicare Advantage insurers have been accused of upcoding, which is when diagnoses are coded up to a more severe (and therefore more lucrative) diagnosis in order to trigger higher payouts. But none more so than UnitedHealth, according to the new report from Sen. Chuck Grassley, R-Iowa, which states that the company has “turned risk adjustment into a major profit centered strategy".

In addition to civil and criminal investigations into their billing practices, the Department of Justice is also conducting an anti-trust probe into UnitedHealth.