February 25, 2025

UnitedHealth Group under scrutiny by Senate Committee for Medicare billing practices - WSJ

Investing.com -- Sen. Chuck Grassley, who leads the Senate Judiciary Committee, has demanded detailed information on the Medicare billing practices of UnitedHealth Group (NYSE: UNH ). The request was made on Monday and directed to the company's CEO, Andrew Witty. Grassley's letter referenced a series of Wall Street Journal articles published over the past year, highlighting alleged fraud, waste, and abuse within the company's practices.

According to data analysis by the Journal, UnitedHealth received billions of dollars based on diagnoses added to patients' Medicare records, even if their doctors had not treated the conditions. This practice is linked to the Medicare Advantage program, a private version of the federal program, where insurers overseeing patients' benefits receive larger payments when people are diagnosed with certain illnesses.

Grassley, a Republican from Iowa, has asked UnitedHealth to provide training manuals and guidance documents related to practices that can result in extra payments. These practices include in-home visits by company nurses and reviews of medical charts. Further, he requested information on UnitedHealth's compliance program, audit results, lists of used software, and other documents.

The Journal's data analysis also revealed that from 2019 to 2021, Medicare Advantage insurers collectively received $50 billion in payments for diagnoses that weren't listed in claims by any treating doctors or hospitals. This scrutiny on UnitedHealth comes as Republicans focus on federal healthcare spending as a potential avenue for fulfilling President Trump's promise to cut the budget. Grassley has set a deadline of March 10 for UnitedHealth to provide the requested documents.

In response, UnitedHealth issued a statement on Tuesday, expressing their readiness to share the facts with Senator Grassley. The company defended itself against what it termed an ongoing misinformation campaign by the Journal. The statement emphasized UnitedHealth's adherence to the highest ethical standards in their practices. The company also claimed that its Medicare Advantage plans provide better health outcomes and lower costs, and that it performs well in audits.

UnitedHealth's statement also addressed a recent report by the Journal suggesting that the Justice Department is investigating the company's Medicare billing practices. The company called any claim of fraudulent practices outrageous and false. Following this report, UnitedHealth's shares fell by more than 7% on Friday. They were down another 1.5% today following news of Grassley's letter.

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