UnitedHealth Group Inc. is facing mounting scrutiny following a report that the company is the subject of a criminal investigation into its Medicare Advantage billing practices. According to a recent article from BenefitsPRO, the U.S. Department of Justice has been conducting the probe since at least mid-2024. Although UnitedHealth stated it has not been formally notified, the news triggered an 18% drop in the company’s stock, adding to a tumultuous week that included the sudden replacement of its CEO and the suspension of 2025 guidance.
The investigation reportedly centers around Medicare Advantage coding practices, where insurers receive higher reimbursements for patients diagnosed with more serious conditions. According to a report from The Wall Street Journal, watchdogs and whistleblowers have long alleged that some insurers exaggerate these diagnoses to boost payments. UnitedHealth, while denying wrongdoing, is already defending itself in a civil case involving over $2 billion in alleged overcharges, though it received a favorable ruling in that matter earlier this year.
This potential criminal probe highlights growing concerns over how Medicare Advantage plans are administered and reimbursed. As one of the most lucrative sectors for insurers, Medicare Advantage has drawn attention for both its financial rewards and its compliance risks. If regulators intensify their focus, insurers may respond by increasing audits, tightening contractual terms, or shifting compliance burdens onto providers.
Healthcare providers working with Medicare Advantage plans should closely examine their billing and documentation practices. Coding accuracy, contract language, and third-party billing oversight are now more important than ever.
With scrutiny increasing, providers must take a proactive approach to compliance rather than waiting for issues to arise. Whether you’re navigating audits, disputes, or internal reviews, having the right legal guidance is key.
For support with Medicare Advantage compliance, payer negotiations, or audit response, contact Thomas J. Force, Esq., President and Founder of Patriot Group, at [email protected] or (631) 870-4040. Patriot Group provides legal and compliance services designed to protect healthcare providers in today’s evolving regulatory environment.
