Former employees at UnitedHealth Group Inc (NYSE:UNH, ETR:UNH) are being questioned by the US Department of Justice (DOJ) as part of its ongoing criminal investigation into the company’s Medicare Advantage billing practices, according to a Wall Street Journal report.
Prosecutors from the DOJ’s healthcare-fraud unit, along with the FBI and the Department of Health and Human Services’ Office of Inspector General, have been interviewing former doctors, nurses, and other staff about how UnitedHealth deployed medical personnel to collect diagnoses that increased Medicare reimbursements, the publication reported.
The DOJ investigation, initiated in 2024, is investigating allegations that UnitedHealth may have engaged in upcoding, reporting patients as sicker than they actually were to secure higher federal payments.
The WSJ added that in 2021, UnitedHealth received $8.7 billion for diagnoses not documented in treatment claims, raising questions about the accuracy of its coding practices.
UnitedHealth defended its Medicare Advantage program. In a statement, the company said: “Today’s article from The Wall Street Journal represents a continuation of its sustained campaign against Medicare Advantage, relying on incomplete data, a predetermined narrative and a flawed understanding of how the Medicare Advantage program works.”
The company also asserts that it maintains some of the most accurate coding practices in the industry.
Shares of UnitedHealth were down 2.4% at about $300, having plunged more than 40% in the year to date.