The Department of Justice is looking into UnitedHealth’s practices for recording diagnoses that lead to extra payments to its Medicare Advantage plans, according to the Wall Street Journal.
A new Wall Street Journal report reveals that the Justice Department is conducting a civil fraud investigation into UnitedHealth Medicare billing practices. The probe is separate from the DOJ’s antitrust investigation that the Journal reported on last year.
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Neither the DOJ nor the Department of Health and Human Services’ Office of Inspector General would comment on the report.
For the latest article, The Wall Street Journal relied on doctors and a nurse practitioner who said that they were questioned about the specific diagnoses that UnitedHealth encouraged them to use with patients, incentive arrangements, and pressure to add the diagnoses. The sources said the company trained them to document the diagnoses, even if they were irrelevant, and used software to suggest conditions. Doctors were paid bonuses when they considered the suggestions, according to the Wall Street Journal.
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The report follows a series of articles published in the last year by The Wall Street Journal spotlighting UnitedHealth’s practices, including Medicare Advantage patients’ unusually high sickness or risk adjustment factors, billing Medicare for diseases that patients never had, and insurer home visits conducted by nurses.
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The company stock crashed to a 10-month low after the latest report, according to Investor’s Business Daily.
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UnitedHealth, the largest health insurer in the United States, said in response to the latest piece, that the Wall Street Journal continues to report misinformation on the Medicare Advantage program and the government regularly reviews all Medicare Advantage plans to ensure compliance and the company consistently performs at the industry’s highest levels on those reviews.
“We are not aware of the ‘launch’ of any ‘new’ activity as reported by the Journal. We are aware, however, that the Journal has engaged in a year-long campaign to defend a legacy system that rewards volume over keeping patients healthy and addressing their underlying conditions. Any suggestion that our practices are fraudulent is outrageous and false,” UnitedHealth said.