Healthcare company UnitedHealth Group is collaborating with a Department of Justice (DOJ) inquiry
UnitedHealth Group, the largest supplier of Medicare Advantage plans, is currently cooperating with federal authorities in an ongoing investigation into potential Medicare Advantage fraud. The probe, believed to be the largest of its kind, was initiated by the Department of Justice (DOJ) in February 2024 and has intensified in recent years due to increased scrutiny on Medicare fraud.
The investigation appears to be centering around UnitedHealth's Medicare Advantage plans, private insurance plans offered as an alternative to traditional Medicare. The company first reached out to the DOJ after media reports surfaced of a federal probe into its Medicare program participation. Since then, UnitedHealth has been complying with formal criminal and civil requests related to the investigation.
Despite the ongoing investigation, UnitedHealth maintains full confidence in the legality and accuracy of its Medicare Advantage practices. This confidence is grounded in a decade-long prior civil challenge by the DOJ where a court-appointed Special Master found no evidence of wrongdoing by UnitedHealth in its Medicare Advantage business.
In an effort to ensure transparency and reinforce compliance, UnitedHealth has launched its own independent initiative involving third-party reviews focusing on its risk assessment coding, managed care practices, and pharmacy services. This initiative is designed to evaluate policies, practices, processes, and associated performance metrics.
The company emphasizes its long history of responsible conduct and effective compliance. Independent audits by the Centers for Medicare & Medicaid Services (CMS) reportedly confirm that UnitedHealth’s practices rank among the most accurate in the industry.
UnitedHealth Group has expressed its commitment to maintaining integrity and serving as a responsible steward of public funds, while also conducting its own compliance reviews to ensure continued adherence to laws and regulations. The company's cooperation with federal authorities is ongoing, and updates will be provided as more information becomes available.
Key points:
- UnitedHealth is cooperating with federal authorities in an ongoing investigation into potential Medicare Advantage fraud.
- The investigation is believed to be the largest probe into Medicare Advantage fraud to date.
- UnitedHealth maintains full confidence in the legality and accuracy of its Medicare Advantage practices.
- UnitedHealth has launched an independent initiative involving third-party reviews to ensure transparency and compliance.
- UnitedHealth emphasizes its long history of responsible conduct and effective compliance.
- UnitedHealth Group is committed to maintaining integrity and serving as a responsible steward of public funds.
- The ongoing investigation into potential Medicare Advantage fraud, believed to be the largest of its kind, involves UnitedHealth Group, the largest supplier of Medicare Advantage plans.
- UnitedHealth Group's Medicare Advantage practices are the subject of scrutiny in this investigation, with the company complying with formal requests from the Department of Justice (DOJ).
- Despite the ongoing investigation, UnitedHealth Group maintains confidence in the legality and accuracy of its Medicare Advantage practices, citing a decade-long prior civil challenge by the DOJ that found no evidence of wrongdoing.
- In response to the investigation and to ensure transparency and reinforce compliance, UnitedHealth Group has launched an independent initiative involving third-party reviews focusing on its risk assessment coding, managed care practices, and pharmacy services.
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