The Justice Department, now headed by U.S. Attorney General Pam Bondi, is reportedly investigating Medicare billing practices from UnitedHealth Group, a move which comes weeks after the assassination of Brian Thompson, the chief executive of subsidiary UnitedHealthcare.
The attorneys are reportedly examining possible civil fraud linked to UnitedHealth Group’s practices for recording diagnoses that allow for extra payments to Medicare Advantage plans, according to a Friday exclusive report from The Wall Street Journal.
That includes potential fraud at physician groups owned by UnitedHealth Group.
Insurers receive payments under the Medicare Advantage system to oversee benefits for enrollees, but the payments increase when certain diagnoses are discovered.
That creates an incentive to diagnose more ailments and receive more payouts.
The Journal previously reported that Medicare paid UnitedHealth Group billions of dollars for “questionable diagnoses.”
Justice Department attorneys have been interviewing some of the same medical providers mentioned in the outlet’s investigations.
The Justice Department is also pursuing an antitrust probe against UnitedHealth Group, and has filed to prevent the insurance behemoth’s $3.3 billion potential acquisition of home healthcare company Amedisys.
The reported civil fraud investigation is separate from those cases.
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UnitedHealth Group accused the Journal in a statement of reporting “misinformation.”
“The government regularly reviews all MA plans to ensure compliance and we consistently perform at the industry’s highest levels on those reviews,” the company said. “We are not aware of the ‘launch’ of any ‘new’ activity as reported by the Journal.”
“We are aware, however, that the Journal has engaged in a year-long campaign to defend a legacy system that rewards volume over keeping patients healthy and addressing their underlying conditions,” the company claimed.
“Any suggestion that our practices are fraudulent is outrageous and false.”
The Journal nevertheless stood by its reporting.
The reported investigation into UnitedHealth Group comes after Brian Thompson, the chief executive of UnitedHealthcare, was assassinated in New York City.
The suspected assassin, Luigi Mangione, was later arrested at a McDonald’s restaurant in Altoona, Pennsylvania, more than 200 miles away from the site of the killing.
The 26-year-old Ivy League graduate and son of a wealthy Maryland family, who has since emerged as a hero of the anti-capitalist left, wrote a manifesto that reflected the ideology of Ted Kaczynski, the terrorist known as the Unabomber.
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