DOJ probes UnitedHealth for alleged Medicare overbilling
UnitedHealthcare is in trouble again as the insurance giant grapples with further government investigation of its Medicare billing practices
The U.S. Justice Department has recently launched a probe into UnitedHealth's Medicare billing practices in the past months. The investigation includes the pursuit of employee buyouts and potential layoffs within the corporation. This situation only exacerbates the public scrutiny the company was already facing.
According to the Wall Street Journal, the civil fraud investigation will examine UnitedHealth's practices for recording diagnoses that trigger additional payments in its Medicare Advantage plans. UnitedHealth claimed in a statement that the report had misinformation about the Medicare Advantage program, and said the company consistently meets the standard of the industry regarding government compliance reviews of its plans.
Why is DOJ probing UnitedHealth?
The U.S. Department of Justice (DOJ) has launched a probe that primarily centers on allegations that UnitedHealth recorded diagnoses which lead to increased payments for its Medicare Advantage plans, potentially resulting in billions of dollars in questionable claims.
Reports suggest that UnitedHealth's practices included practices such as training doctors to document revenue-generating diagnoses, utilizing software to suggest additional conditions, and offering bonuses for incorporating said suggestions. Some diagnoses were reportedly added without proper testing or treatment. This raised concerns about the legitimacy of the company's billing practices. UnitedHealth has denied any fraudulent activity, stating they are unaware of any new DOJ actions and criticizing the allegations as false.
UnitedHealth under public scrutiny again
This recent probe against UnitedHealth only adds to previous government lawsuits over similar issues. The company is known for expanding its control over the healthcare industry in the U.S., which many see as a direct threat to the health of thousands of Americans. Some examples of these allegations include:
- Acquisition of healthcare providers: UnitedHealth, through its Optum division, has aggressively acquired hospitals, physician groups, and pharmacies, raising antitrust concerns.
- Potential monopoly concerns: Critics argue that UnitedHealth’s dominance in insurance, medical services, and data analytics could reduce competition and increase healthcare costs.
- Congressional scrutiny: Lawmakers have raised concerns about UnitedHealth’s influence and the potential risks of corporate consolidation in healthcare