The Justice Department’s health-care fraud unit is investigating UnitedHealth for Medicare Advantage fraud, reports the Wall Street Journal. UnitedHealth denies knowledge of the investigation. Regardless, its stock was down more than 50 percent in the last two months and down eight percent directly after the WSJ published its story.
A slew of investigations into the civil and criminal conduct of UnitedHealth in its administration of its Medicare Advantage HMO plans suggest massive wrongdoing by the company. The HHS Office of the Inspector General has issued several reports showing widespread and persistent inappropriate delays and denials of care in Medicare Advantage, perpetrated by corporate health insurers. The Medicare Payment Advisory Commission has found overpayments to Medicare Advantage insurers to the tune of $84 billion this year alone. UnitedHealth is the largest of the Medicare Advantage insurers, covering nearly 10 million older and disabled Americans, 29 percent of people in Medicare Advantage.
Stephen Helmsley just took over from Andrew Witty as the new head of UnitedHealth Group. Helmsley headed UnitedHealth for more than ten years before Witty took over.
The WSJ reported that the Justice Department was undertaking a civil fraud investigation into UnitedHealth’s Medicare Advantage conduct back in February. That month, Senator Chuck Grassley began looking into how UnitedHealth charges the government for its Medicare Advantage enrollees. The evidence suggests that UnitedHealth “upcodes,” adding additional diagnoses to patient records, even though it is not treating patients for those diagnoses, in order to generate higher payments from the government.
Here’s more from Just Care:
- UnitedHealth’s stock price dropped significantly; more care denials likely
- Senator Grassley takes on UnitedHealth Medicare Advantage overpayments
- UnitedHealth, CVS and Cigna helped fuel opioid crisis
- What’s more dangerous than dozens of insurers offering Medicare Advantage? UnitedHealth for All
- UnitedHealth’s denials of critical rehab services is under investigation
