(VOR News) – According to local media, UnitedHealthcare’s Medicare billing practices are under investigation by the US Department of Justice.
According to a Wall Street Journal story, the federal government is investigating whether UnitedHealthcare is misusing patient diagnoses to boost the lump sum monthly payments it receives under the Medicare Advantage program.
With a $457 billion market capitalisation, UnitedHealthcare is among the largest companies in the world, despite being best known for its insurance division. UnitedHealthcare technology, medical treatments, and pharmaceutical benefits are among its business interests.
Given the size of the company, one industry analyst estimated that its infrastructure would handle 5% of US GDP daily. It will employ more than 90,000 doctors by 2023, making it the largest employer of physicians in the United States. It accounts for more than ten percent of all doctors in the country.
UnitedHealthcare Justice was supposed to investigate civil fraud.
About 65 million people in the US are covered by Medicare, a public health insurance program for the elderly and disabled. Medicare Advantage programs are enrolled by roughly half of subscribers.
Through a process governed by Congress, these plans grant private insurers the power to supervise enrollee care.
The idea’s proponents argue that since private businesses could more efficiently provide the same services as the government, taxpayers would save money. When the idea was first presented to the public, George W. Bush was president.
But according to some estimates, the scheme is probably going to boost government expenses by billions of dollars every year. A report by the Medicare Payment Advisory Commission (Medpac) estimates that the cost of Medicare Advantage plans to taxpayers will be around $83 billion this year, a 22% increase above the cost of standard Medicare.
Furthermore, a growing number of people have expressed discontent with the program’s potential to make healthcare access more difficult. For example, the program requires patients to acquire their insurer’s consent, often known as “prior authorisation,” prior to beginning therapy.
The magazine reports that UnitedHealthcare is being investigated by the Department of Justice’s civil fraud section and the inspector general’s office at the Department of Health and Human Services.
This is not the Justice Department’s UnitedHealthcare antitrust probe.
Following the publication of the report, UnitedHealthcare issued the following statement: “The Wall Street newspaper continues to propagate misinformation regarding the Medicare Advantage (MA) program.”
The government conducts routine evaluations of Medicare Advantage programs to ensure compliance with regulations. We routinely outperform the industry standard.
The following passage is taken from the response: “We are not aware of the ‘launch’ of any ‘new’ activity as reported by the Journal.” We are aware, however, that the Journal has been fighting for a year to solve the underlying causes of their predicament and to preserve a legacy system that prioritises volume over UnitedHealthcare.
The claim that our business practices are fraudulent is not only ludicrous, but it is also unsupported by any facts.
The large company has also faced criticism for a variety of business practices. Change Healthcare is a technology company that manages up to one-third of all insurance payments to particular providers. Change Healthcare is privately owned by UnitedHealth Group.
Hackers were able to “exfiltrate” up to 85 million medical records following a major data breach in 2024. This event was the “Deepwater Horizon moment” in the history of healthcare, according to one informed expert.
UnitedHealthcare has been under increased investigation since the murder of its CEO, Brian Thompson. After the executive, who was portrayed as a family-oriented and compassionate man, was slain, the American people, who had earlier shown discontent over the fact that they were routinely refused access to healthcare, replied with contempt and apathy.
During the early morning trading session, UnitedHealth’s stock fell 10% as a result of the revelation.
SOURCE: TG
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