US DOJ investigates UnitedHealth for alleged Medicare fraud: Report

Al Jazeera

15-05-2025

The United States Department of Justice (DOJ) is carrying out a criminal investigation into UnitedHealth Group for possible Medicare fraud.
The Wall Street Journal (WSJ) first broke the story on Wednesday.
UnitedHealth said it had not been notified by the DOJ about the 'supposed criminal investigation reported', and the company stood by 'the integrity of our Medicare Advantage program'.
The DOJ's healthcare-fraud unit is overseeing the criminal investigation, which focuses on the company's Medicare Advantage business practices, WSJ reported, citing people familiar with the matter.
While the exact nature of the potential criminal allegations against UnitedHealth is unclear, it has been an active probe since at least last summer, the newspaper said.
A DOJ spokesperson declined to comment to the WSJ about the fresh criminal probe. The department did not immediately respond to requests for comments from the Reuters news agency.
Last week, UnitedHealth said in a regular filing that it had been 'involved or is currently involved in various governmental investigations, audits and reviews', without disclosing further details.
The new investigation follows broader scrutiny into the Medicare Advantage programme, in which Medicare-approved plans from a private company supplement regular Medicare for Americans age 65 and older by covering more services that the government-only plans do not, such as dental and vision services.
In February, the WSJ reported a civil fraud investigation into UnitedHealth's Medicare practices. The company had then said that it was unaware of any new probe.
In the same month, US Senator Chuck Grassley of Iowa launched an inquiry into UnitedHealth's Medicare billing practices, requesting detailed records of the company's compliance programme and other related documents.
The DOJ earlier this month filed a lawsuit accusing three of the largest US health insurers of paying hundreds of millions of dollars in kickbacks to brokers in exchange for steering patients into the insurers' Medicare Advantage plans.
Nearly half of the 65 million people covered by Medicare, the US programme for people aged 65 and older or with disabilities, are enrolled in Medicare Advantage plans run by private insurers.
The insurers are paid a set rate for each patient, but can be paid more if patients have multiple health conditions. Standard Medicare coverage is managed by the government.
The health insurer has been under pressure for months. On Tuesday, UnitedHealth Group's CEO, Andrew Witty, stepped down unexpectedly, and the company simultaneously suspended its 2025 financial forecast due to rising medical costs, triggering an 18 percent drop in shares to a four-year low.
Stephen Hemsley, who led the company for more than a decade until 2017, is taking back the reins following setbacks including the December murder of Brian Thompson, the CEO of its insurance unit, which catapulted UnitedHealth into the public consciousness.
On Thursday, after the news of the probe broke, UnitedHealth Group shares plunged 18 percent to hit a five-year low.
'The stock is already in the doghouse with investors, and additional uncertainty will only pile on,' James Harlow, senior vice president at Novare Capital Management, which owns shares in UnitedHealth, told the news agency Reuters.
If losses hold, UnitedHealth will be the worst-performing stock on the S&P 500 index in two of the last three days.
The past month's selloff has wiped out nearly $300bn from UnitedHealth's market capitalization, or more than half of its value since its shares hit a record high in November.