UnitedHealth beneath prison investigation for potential medicare fraud: Report

The US Division of Justice (DOJ) is investigating UnitedHealth Group for potential Medicare fraud, the Wall Avenue Journal reported on Wednesday. In line with the report, the Justice Division’s healthcare fraud unit is main the probe, which has reportedly been lively since not less than mid-2023.

Officers conversant in the case advised the Journal that the probe is targeted on UnitedHealth’s Medicare Benefit enterprise. It’s a program during which non-public insurers, like UnitedHealth, obtain cost from the federal government to supply Medicare advantages to the aged and disabled.

Neither the Justice Division nor UnitedHealth has issued any assertion on the investigation. The investigation comes on prime of a number of different probes into the corporate, together with whether or not it has been its billing practices and potential antitrust violations.

STOCK TROUBLES, EXECUTIVE SHAKE-UPS

The probe hits UnitedHealth at a difficult time. The inventory worth has fallen arduous, plummeting nearly 50% during the last month. The decline occurred after the alternative of its CEO. Andrew Witty resigned this week and was succeeded by Stephen Hemsley, the previous CEO and now chairperson of the corporate.

UnitedHealth has additionally had a tricky yr. In 2023, a cyberattack on one in every of its expertise models led to months of delayed funds to US healthcare suppliers. The corporate additionally needed to take care of the homicide of a high-ranking government in its insurance coverage enterprise.

DOJ OLD CASE STILL UNRESOLVED

The Justice Division’s prison fraud part specialises in cracking down on health-related offences like false billing and kickbacks.

But it surely has struggled in earlier makes an attempt to substantiate fraud prices in opposition to UnitedHealth. In March, a court-appointed particular grasp advisable dismissing a longstanding whistleblower criticism. The criticism was associated to $2 billion value of disputed diagnoses that, by inside critiques, weren’t documented in sufferers’ medical charts.

Though the decide didn’t situation a choice, the Justice Division argued in opposition to the advice. UnitedHealth mentioned the discovering confirmed “there was no proof to help the DOJ’s claims we had been overpaid or that we did something fallacious.