UnitedHealth says it’s complying with DOJ probes into Medicare practices

Insurance giant UnitedHealth Group confirmed in a securities filing on Thursday, July 24, that it is cooperating with a Department of Justice investigation into its Medicare billing practices. The Wall Street Journal reported in a series of articles that UnitedHealth billed extra diagnoses to its Medicare Advantage programs to inflate its payments from the federal government.

Kuai Leong, senior deputy general counsel and deputy corporate secretary at UnitedHealth Group, wrote in the filing to the United States Securities and Exchange Commission that UnitedHealth reached out to the Justice Department following media reports about the company’s billing practices. According to the WSJ reports, UnitedHealth trained doctors to document diagnoses that would, in turn, generate more funding for the health care company.

Medicare Advantage is a public health insurance program covering more than 65 million elderly and disabled Americans. The Justice Department’s health care fraud unit is leading a criminal investigation into the insurer for Medicare fraud while also pursuing civil litigation under the False Claims Act.

The Justice Department didn’t immediately respond to Straight Arrow News’ request for comment. UnitedHealth shared a statement on June 24, repeating what Leong wrote in the filing. 

“The Company has now begun complying with formal criminal and civil requests from the Department,” Leong wrote. “The Company has full confidence in its practices and is committed to working cooperatively with the Department throughout this process.”

His comments come as UnitedHealth faces scrutiny from federal officials about its operations under the Medicare Advantage Program. 

2017 investigation

The Justice Department intervened in a 2017 lawsuit filed by whistleblower Benjamin Poehling, a former finance director for UnitedHealth who managed the company’s Medicare Advantage plans. The department said in a 2017 release that the company instructed physicians to falsely document diagnoses to trigger risk adjustments by Medicare.

Under Medicare Advantage, the government paid insurers adjusted amounts based on the beneficiaries’ health status submitted by doctors. UnitedHealth had more Medicare Advantage enrollees than any other insurer, according to nonprofit health policy research firm KFF. 

Federal prosecutors said the company conducted reviews and identified diagnoses that physicians had not reported, which would have resulted in increased payments. Prosecutors also accused the insurer of giving financial incentives to document and furnish the diagnoses. 

“However, UHG allegedly ignored information from these chart reviews showing that hundreds of thousands of diagnoses provided by treating physicians and submitted by it to Medicare were invalid and did not support the Medicare payments it had previously requested and obtained,” the DOJ wrote in 2017. “By ignoring this information, UHG avoided repaying Medicare monies to which it was not entitled.”

However, Leong wrote that a court-appointed special master reviewed the case and found no evidence supporting claims of wrongdoing. 

New criminal inquiry

The Wall Street Journal reported in May that the Justice Department launched a criminal inquiry into the insurer for Medicare fraud. Citing people familiar with the investigation, the Journal said the DOJ was focusing on UnitedHealth’s Medicare Advantage business practices. 

Leong wrote that UnitedHealth has launched a third-party review of its policies, practices and any associated processes and performance metrics for risk assessment coding, managed care practices and pharmacy services.