Sat Feb 22 19:10:00 UTC 2025: ## Justice Department Investigates UnitedHealthcare Over Medicare Advantage Billing Practices

**Washington, D.C.** – The US Department of Justice (DOJ) has launched a civil fraud investigation into UnitedHealthcare, the nation’s largest health insurer, focusing on its billing practices within the Medicare Advantage program. The investigation, conducted jointly with the Department of Health and Human Services Office of Inspector General, centers on allegations that UnitedHealthcare is improperly using patient diagnoses to inflate the monthly payments it receives from the government.

Medicare Advantage, a program allowing private insurers to manage Medicare beneficiaries’ care, serves approximately half of the 65 million Americans enrolled in Medicare. While initially touted as a cost-saving measure, studies now indicate it may cost taxpayers billions of dollars more annually than traditional Medicare. A recent MedPAC report estimates an $83 billion (22%) cost overrun in 2024 alone.

The DOJ’s investigation comes amidst growing concerns about access to care within the Medicare Advantage system, with patients reporting difficulties obtaining necessary treatments due to prior authorization requirements. UnitedHealthcare, a massive corporation with a $457 billion market capitalization and employing nearly 10% of US doctors, vehemently denies any wrongdoing, calling the allegations “outrageous and false” and accusing the *Wall Street Journal*, which initially reported the investigation, of a biased campaign against the program. The company also points to its consistently high performance in government compliance reviews.

This investigation is separate from an ongoing DOJ antitrust inquiry into the company. Further scrutiny of UnitedHealth Group has been fueled by a major data breach at its subsidiary, Change Healthcare, affecting up to 85 million patient records, and the recent murder of its CEO, Brian Thompson. The news of the DOJ investigation resulted in a 10% drop in UnitedHealth’s stock price. The outcome of the investigation could have significant implications for the future of Medicare Advantage and the healthcare industry as a whole.

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