Things continue to spiral for the embattled UnitedHealth.
UnitedHealth Group, the largest health insurer in the United States, is reportedly the subject of a federal criminal investigation for potential Medicare fraud, according to an exclusive report by the Wall Street Journal.
The investigation, led by the U.S. Department of Justice’s health-care fraud unit in New York, has been underway since at least the summer of 2024 and centers on the company’s Medicare Advantage business practices, according to the report.
Medicare Advantage, a program that provides private insurance alternatives to traditional Medicare, serves over 8.2 million members through UnitedHealth, making it a significant revenue driver.
The Journal, citing sources familiar with the matter, indicated that the DOJ is examining UnitedHealth’s business practices, though specific details of the alleged criminal activities remain undisclosed.
The probe represents a serious escalation in scrutiny for UnitedHealth, which has faced questions about its Medicare Advantage operations in the past, including scrutiny into billing practices and an investigation into potential antitrust violations.
UnitedHealth issued a statement denying that it has been formally notified by the DOJ of any criminal investigation into its practices.
The company described the Wall Street Journal’s reporting as “deeply irresponsible” and expressed strong confidence in the compliance and integrity of its Medicare Advantage program, according to Newsweek.
This news comes amid a tumultuous period for UnitedHealth, marked by the sudden resignation of its chief executive officer, Andrew Witty, on Tuesday.
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Reuters reported that Witty, who has led UnitedHealth since 2021, stepped down for personal reasons, with no further explanation provided by the company.
Witty will be succeeded by Stephen Hemsley, a former CEO who guided UnitedHealth from 2006 to 2017 and is now returning to lead the company through this challenging time.
On the same day as Witty’s departure, UnitedHealth announced it was suspending its 2025 financial forecast, attributing the decision to higher-than-expected medical costs.
The combination of the CEO’s exit and the halted forecast sent UnitedHealth’s stock plummeting. The company’s stock “has declined by more than 50 percent over the past month,” the Wall Street Journal reported. “Thursday, it fell 16 percent and was poised for its lowest closing price since 2020.”
UnitedHealth has faced prior scrutiny over its Medicare billing practices, with the Journal reporting in February about a civil fraud investigation involving similar concerns.
That civil probe focused on whether UnitedHealth engaged in upcoding, a practice where patient diagnoses are exaggerated to secure higher payments from the Medicare program.
And that doesn’t even begin to delve into the horrific murder of former Brian Thompson, CEO of UnitedHealth’s insurance division, allegedly by Luigi Mangione.
The DOJ has not publicly commented on the latest reported investigation.
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