The U.S. Department of Justice has reportedly launched a civil fraud investigation into insurance giant UnitedHealth concerning its practices involving Medicare Advantage plans.
According to the Wall Street Journal, which cites “people familiar with the matter,” the probe is examining UnitedHealth’s practices for recording a patient’s diagnosis that results in an extra payment by Medicare. Those payments allegedly went to the company’s Medicare Advantage plans.
Under Medicare Advantage, health insurance companies receive payments from the U.S. government to monitor and manage recipients’ benefits. If a patient has a certain diagnosis, the payments increase.
The Journal has been investigating the matter for several months and has interviewed a number of healthcare providers. The newspaper’s reporting claimed that Medicare paid UnitedHealth billions of dollars for “questionable diagnoses.”
The Journal’s previous reporting cited doctors who claimed UnitedHealth trained them to make “revenue-producing diagnoses,” some that were described as “obscure or irrelevant.”
According to the Journal, neither UnitedHealth nor any government agency has offered a comment on the report.
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