The US government has launched a massive investigation into UnitedHealth Group, the nation’s largest provider of Medicare Advantage benefits. The probe is unprecedented due to its scope and severity. UnitedHealthcare is being scrutinized by both the Department of Justice and the IRS in separate civil and criminal investigations.
UnitedHealthcare is not only accused of inflating government payments but also accused of upcoding, a practice where they manipulate diagnosis codes to make patients appear sicker, thereby increasing their federal reimbursement. This scheme has been criticized as a form of “gaming” the system.
The Medicare Advantage program, which draws over 40 million members, has seen significant growth over the past decade. However, allegations that private insurers like UnitedHealthcare have engaged in wrongdoing to maximize government payments have raised concerns among experts.
“The Department of Justice’s actions against [Medicare Advantage insurers] have been civil,” said David Lipschutz, co-director of the Center for Medicare Advocacy. “I don’t recall any criminal cases.”
Source: https://www.startribune.com/dojs-unitedhealth-investigation-likely-biggest-medicare-advantage-fraud-probe-yet/601442980