While Luigi Mangione today stands trial for the killing of UnitedHealthcare CEO Brian Thompson, the U.S. Justice Department is launching a civil fraud investigation into the conglomerate’s Medicare billing practices. The probe evaluates whether UnitedHealth’s system accurately records diagnoses, The Wall Street Journal reports, especially as some lead to higher revenue for the company.
UnitedHealth is a $400 billion corporation that owns the largest U.S. health insurer, United Healthcare, along with a number of other health-related services. The DOJ’s scrutiny surrounds its practices' recording diagnoses, which trigger payments to its Medicare Advantage plans.
Medicare Advantage plans are private insurance options for seniors offering more benefits than regular Medicare, such as additional coverage for dental, vision, and hearing plans. In 2024, over half of Medicare users, or 32.8 million people, were enrolled in Medicare Advantage plans; the U.S. government pays private insurers a lump sum payment to oversee these plans.
Last year, the Journal reported that UnitedHealth Group had racked up billions of dollars from Medicare Advantage payments—and specifically, that Medicare paid increased funds for “questionable” diagnoses. Doctors told the Journal that UnitedHealth encouraged them record profitable diagnoses, even if they were vague, unclear or peripheral—and even paid out bonuses to this effect. While the lucrative diagnoses proved to greatly benefit the conglomerate, patients questioned whether they were fair.
Some doctors alleged they were directed to document diagnoses that they didn’t actually address. In 2021, UnitedHealth diagnoses generated $8.7 billion for the company for illnesses that were never treated. (That year, the conglomerate’s net income was $17 billion.) And between 2019 to 2021, Medicare Advantage insurers (including UnitedHealth Group) recorded untreated diagnoses on patient profiles that triggered an extra $50 billion.
In January, DOJ lawyers questioned some of the medical workers who had spoken to the Journal. They were asked about alleged incentives surrounding their diagnosis-making and whether they felt pressured to record inaccurate information. Some affirmed that they were encouraged to make new diagnoses on top of what was treated.
UnitedHealth has shot down criticism of their billing practices, however. The company asserts that their system diagnoses patients accurately and passes Medicare audits. They’ve also maintained that the system detects diseases early, which both helps patients and saves money for the healthcare industry in the long run.
In a recent statement, they claimed the Journal reported “misinformation” and said the idea that their practices are fraudulent is “outrageous and false.”
Still, it’s not the first time that UnitedHealth has been inspected for the same problem. The DOJ’s current investigation took over an earlier lawsuit by a former UnitedHealth employee who claimed that the company failed to remove inaccurate diagnoses from patient records.
The DOJ also sued UnitedHealth last November, preventing them from finalizing an over $3 billion acquisition of Amedisys, a company that offers hospice and palliative care, out of concern that UnitedHealth Group would gain too much power over the market. UnitedHealth Group currently controls 15% of the health insurance market.
The company has especially faced serious criticism in the last few months following the shooting of CEO Brian Thompson. The alleged shooter, 26-year-old Luigi Mangione, will today appear in court to face charges.
According to a New York Police Department report, Mangione was allegedly provoked by “corporate greed.” His arrest prompted a wave of support from protestors decrying for-profit health care corporations.
