UnitedHealth Group confirmed Thursday that the company is facing both criminal and civil investigations from the Department of Justice (DOJ) related to its Medicare billing practices.
The health care giant said in a securities filing and subsequent statement it has begun complying with formal criminal and civil requests.
UnitedHealth’s stock was also down a little under 4 percent on Thursday.
“The Company has a long record of responsible conduct and effective compliance,” UnitedHealth said in its filing. “Independent CMS audits confirm that the Company’s practices are among the most accurate in the industry, and, following a decade-long civil challenge by the Department to aspects of our Medicare Advantage business, a court-appointed Special Master concluded there was no evidence to support claims of wrongdoing.”
UnitedHealth said it has launched its own initiative to conduct third party reviews of “policies, practices, and associated processes and performance metrics for risk assessment coding, managed care practices, and pharmacy services.”
The disclosure marks the first time the company has acknowledged the existence of any DOJ investigations, and it comes after a series of Wall Street Journal articles in recent months brought the details to light.
The company said it “proactively” reached out to the DOJ after reviewing media reports about the agency’s investigations.
The Journal reported in February that DOJ launched a civil investigation into whether the company inflated diagnoses to trigger extra payments to its Medicare Advantage (MA) plans, which are privately run insurance plans reimbursed by the federal government. The outlet first reported on the criminal Medicare fraud probe in May.
UnitedHealth is the largest insurer in the MA market.
Thursday’s announcement comes ahead of its second-quarter earnings call on July 29 and could mark a shift in strategy under new CEO Stephen Hemsley, who took over in May after Andrew Witty suddenly stepped down.
The company has experienced a tumultuous year that included suspending its 2025 earnings forecast, partly due to higher medical costs for new MA plan enrollees.
