UnitedHealth Faces Investigation from U.S. Department of Justice

UnitedHealth has begun complying with formal criminal and civil requests from the U.S. Department of Justice after media reports about investigations into its participation in the Medicare program, according to a filing.

This is the first time the health care conglomerate has publicly acknowledged the probes. Shares of the company fell nearly 4% to $280.90 in premarket trading.

Background on the Investigation

The company has full confidence in its practices and is committed to cooperating with the DOJ throughout this process, according to the filing.

Medicare is a U.S. government program that covers medical costs for individuals aged 65 and older as well as those with disabilities.

What is Medicare?

Medicare is a vital program that provides health coverage to millions of Americans. It is a federal health insurance program that is divided into several parts, including Part A, Part B, Part C, and Part D. Part A covers hospital stays, skilled nursing care, and hospice care, while Part B covers doctor visits, outpatient care, and medical equipment. Part C, also known as Medicare Advantage, is a type of health insurance plan that contracts with the federal government to provide Medicare benefits. Part D, on the other hand, covers prescription medications.

The Investigation into UnitedHealth

The Wall Street Journal has published a series of reports stating the DOJ is investigating UnitedHealth’s Medicare business.

The Journal reported earlier this month that former employees of UnitedHealth were questioned by prosecutors working for the health care fraud unit in recent weeks about the company’s efforts to record specific diagnoses that generate higher payments and document lucrative diagnoses, including testing patients and sending nurses to patients’ homes.

Impact on UnitedHealth’s Stock

Once considered a reliable bet, the health care behemoth has lost its appeal following a series of management missteps. UnitedHealth’s stock has fallen more than 40% so far this year.

UnitedHealth’s Response to the Investigation

Independent CMS audits confirm that UnitedHealth’s practices are among the most accurate in the industry, the company said.

It added that following a decade-long civil challenge by the department to aspects of its Medicare Advantage business, a court-appointed Special Master concluded there was no evidence to support claims of wrongdoing.

The company has proactively launched its own initiative to conduct third-party reviews of policies, practices, associated processes and performance metrics for risk assessment coding, managed care practices, and pharmacy services, it added.

What’s Next for UnitedHealth?

The investigation into UnitedHealth is ongoing, and the company is cooperating fully with the DOJ. The outcome of the investigation is still uncertain, but it is clear that UnitedHealth is taking steps to ensure that its practices are compliant with federal regulations.

Conclusion

In conclusion, UnitedHealth is facing an investigation from the U.S. Department of Justice regarding its participation in the Medicare program. The company has acknowledged the investigation and is cooperating fully with the DOJ. While the outcome of the investigation is still uncertain, UnitedHealth is taking steps to ensure that its practices are compliant with federal regulations.

Frequently Asked Questions

Q: What is the investigation into UnitedHealth about?

A: The investigation into UnitedHealth is regarding its participation in the Medicare program and allegations of improper billing practices.

Q: How is UnitedHealth responding to the investigation?

A: UnitedHealth is cooperating fully with the DOJ and has launched its own initiative to conduct third-party reviews of its policies and practices.

Q: What is Medicare?

A: Medicare is a U.S. government program that covers medical costs for individuals aged 65 and older as well as those with disabilities.

Q: How has the investigation affected UnitedHealth’s stock?

A: UnitedHealth’s stock has fallen more than 40% so far this year due to the investigation and other management missteps.