UnitedHealth faces DOJ probe

UnitedHealth Group said it is cooperating with a Department of Justice investigation into its Medicare billing practices. (unitedhealthgroup.com) The company said on July 24, 2025 that it had begun complying with formal criminal and civil requests from the Justice Department after proactively contacting the agency following earlier media reports. CNBC reported the disclosure sent UnitedHealth shares down about 2% that day. (unitedhealthgroup.com) (cnbc.com) The billing issue centers on Medicare Advantage risk adjustment, the formula the Centers for Medicare and Medicaid Services uses to pay private insurers more for members with costlier medical conditions. The Wall Street Journal reporting summarized by Medical Economics said investigators were examining whether added diagnoses raised those risk scores and increased federal payments. (cms.gov) (medicaleconomics.com) UnitedHealth said independent audits by the Centers for Medicare and Medicaid Services found its practices were “among the most accurate in the industry,” and the company said it has “full confidence” in its compliance program. In May 2025, the company also said the Justice Department had previously declined to pursue another set of allegations after a multi-year review. (cnbc.com) (unitedhealthgroup.com) The investigation landed as Medicare Advantage payment policy was moving in Washington. On April 7, 2025, the Centers for Medicare and Medicaid Services finalized the 2026 rate announcement for Medicare Advantage and Part D, saying the update was intended to protect beneficiaries and taxpayers from waste, fraud, and abuse. (cms.gov 1) (cms.gov 2) Federal scrutiny of diagnosis coding in Medicare Advantage has not been limited to UnitedHealth. On January 14, 2026, the Justice Department said Kaiser Permanente affiliates agreed to pay $556 million to resolve False Claims Act allegations that they submitted invalid diagnosis codes to obtain higher Medicare Advantage payments. (justice.gov) Outside analysts and policy groups have been tracking the same payment mechanics. A Kaiser Family Foundation analysis of 2022 encounter data found diagnoses added through chart reviews increased payments for one in six Medicare Advantage enrollees, and the Commonwealth Fund said policymakers are weighing reforms aimed at reducing inflated payments tied to risk adjustment. (kff.org) (commonwealthfund.org) UnitedHealth has not been charged in the Medicare billing matter, and the company said it is working cooperatively with investigators. The next test is whether the inquiry ends as an audit fight, a civil fraud case, or nothing at all. (unitedhealthgroup.com)