UnitedHealth under criminal probe for possible Medicare fraud: WSJ

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UnitedHealth under criminal probe for possible Medicare fraud: WSJ

STORY: UnitedHealth Group is under a criminal investigation by the U.S. Justice Department for possible Medicare fraud.

That’s according to a Wall Street Journal report Wednesday, which cited people familiar with the matter.

While the Journal said it’s unclear what the exact criminal allegations are, they say the investigation has been active since at least last summer, undertaken by the healthcare-fraud unit of the DOJ’s criminal division.

It would be the latest in a series of setbacks for UnitedHealth, one of the largest health insurers in the U.S.

Last year it’s seen a cyber attack at its tech unit, the killing of the head of its insurance unit and subsequent public backlash against the industry.

And Wednesday’s report comes a day after UnitedHealth Group’s CEO Andrew Witty unexpectedly stepped down.

The company also suspended its 2025 financial forecast due to rising medical costs.

In February, the Journal reported a civil fraud investigation into UnitedHealth’s practices around Medicare.

In the same month, U.S. Senator Chuck Grassley also launched an inquiry into UnitedHealth’s practices in Medicare billing.

At the time the company had then said that it was unaware of any new probe.

Medicare is the federal health insurance program in the U.S. for people aged 65 and older or with disabilities.

And the report of an new investigation follows broader scrutiny into the Medicare Advantage program.

Nearly half of the 65 million people covered by Medicare are enrolled in Medicare Advantage plans run by private insurers.

The DOJ, earlier this month, had filed a lawsuit accusing three of the largest U.S. health insurers of paying hundreds of millions of dollars in kickbacks to brokers in exchange for steering patients into the insurers’ Medicare Advantage plans.

The insurers are paid a set rate for each patient, but can be paid more if patients have multiple health conditions.

Wednesday’s WSJ report of a new probe sent UnitedHealth shares plunging to a four-year low.

The company and the DOJ did not immediately respond to Reuters requests for comments.

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