By Bruce Gil
UnitedHealth Group (UNH-1.39%) is under fire over its Medicare billing practices.
The Wall Street Journal reported Friday that the U.S. Department of Justice (DOJ) has launched a civil fraud investigation into how the company records diagnoses that lead to extra payments for its Medicare Advantage plans.
[Continue reading below]UnitedHealth stock fell almost 9% in Friday morning trading following the news.
“The government regularly reviews all MA plans to ensure compliance and we consistently perform at the industry’s highest levels on those reviews,” UnitedHealth said in statement. “ We are not aware of the “launch” of any “new” activity as reported by the Journal.”
The statement went on to say “any suggestion that our practices are fraudulent is outrageous and false.”
In Medicare Advantage plans, the U.S. government pays private insurers a set amount of money to manage enrollees’ care. However, if a patient has certain diagnoses, the payments increase.
The Wall Street Journal (NWSA+0.09%) reported a series of articles last year on how Medicare paid UnitedHealth billions of dollars for questionable diagnoses. In December, the outlet analyzed Medicare records and found that patients seen by UnitedHealth-employed doctors saw a sharp rise in lucrative diagnoses after switching to the company’s Medicare Advantage plans.
Multiple doctors told the Journal that they were trained to document revenue-generating diagnoses. They also said that the company used software to suggest conditions and rewarded doctors with bonuses for considering them.
Justice Department attorneys have been following up on these findings, interviewing medical providers named in the Journal’s reports as recently as Jan. 31.
This new investigation is separate from the DOJ’s ongoing antitrust probe against the company. Additionally, the department blocked UnitedHealth’s $3.3 billion acquisition of Amedisys, a home health company last year.
UnitedHealth Group is the parent company of UnitedHealthcare, the nation’s largest health insurer, and the pharmacy benefit manager Optum, which has a vast network of medical practices.
The probe comes after a challenging year for the company. One of its subsidiaries, Change Healthcare, suffered a major cyberattack. Its health insurance arm also faced severe public backlash over its insurance claim denial practices following the murder of UnitedHealthcare CEO Brian Thompson.
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