The Wall Street Journal says the Justice Department in recent months has launched an investigation into UnitedHealth Group’s billing practices as a new civil fraud investigation looks at the use of diagnosis data to trigger extra payments to the company’s Medicare Advantage plans.
Shares of the Eden Prairie-based company’s stock were down roughly 8% in early trading Friday.
“We are not aware of the ‘launch’ of any ‘new’ activity as reported by the Journal,” UnitedHealth Group said in a statement Friday.
“We are aware, however, that the Journal has engaged in a year-long campaign to defend a legacy [Medicare] system that rewards volume over keeping patients healthy and addressing their underlying conditions,” the company said. “Any suggestion that our practices are fraudulent is outrageous and false.”
Medicare Advantage is a privatized version of the federal health insurance program for seniors, where the government hires health plans to manage care for patients and pays companies more when seniors need more treatment — creating a financial incentive for insurers to document as many diagnoses as possible.
Both the Wall Street Journal and the Office of Inspector General at the U.S. Department of Health and Human Services scrutinized the volume of additional payments to UnitedHealth Group’s massive health insurance division, UnitedHealthcare.
Last summer, the Journal reported UnitedHealth added diagnoses to patients’ records for conditions that no doctor treated, triggering billions in extra federal payments. The untreated diagnoses stemmed from sources including in-home visits by nurses working for a company program called HouseCalls.
