UnitedHealth Group, the largest Medicare Advantage health insurer in the United States, said Thursday it is complying with formal criminal and civil requests from the Department of Justice (DOJ).
The insurer released a statement Thursday morning that it has proactively reached out to the DOJ following media reports about investigations into certain aspects of the company’s participation in the Medicare program.
Indeed, the Wall Street Journal has written a series of articles about the investigation. The most recent one, published earlier this month, said that former UnitedHealth employees have been interviewed by prosecutors from the DOJ’s health care fraud unit, the Federal Bureau of Investigation, and the Department of Health and Human Services’ Office of Inspector General.
The investigation reportedly involves specific diagnoses that the company encouraged doctors and nurse practitioners to use and incentive arrangements. Providers interviewed by the Wall Street Journal 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.
UnitedHealth Group said in the statement that it has now begun complying with formal criminal and civil requests from the Justice Department. “The company has full confidence in its practices and is committed to working cooperatively with the department throughout this process,” UnitedHealth Group said.
Despite the ongoing investigation into its practices for recording diagnoses that lead to extra payments to its Medicare Advantage plans, UnitedHealth said it has a long record of responsible conduct and effective compliance. Furthermore, the company said that independent audits conducted by the Centers for Medicare & Medicaid Services confirm that its practices are among the most accurate in the industry, and, following a decade-long civil challenge by the DOJ to aspects of our Medicare Advantage business, “a court-appointed Special Master concluded there was no evidence to support claims of wrongdoing.”
The UnitedHealth statement goes on to say that to ensure its stakeholders have transparency and confidence in its practices, it has proactively launched its own initiative to conduct third-party reviews of policies, practices, and associated processes and performance metrics for risk assessment coding, managed care practices, and pharmacy services.
UnitedHealth said it is “committed to maintaining the integrity of its business practices and serving as reliable stewards of American tax dollars.”