The Wall Street Journal reveals new details about the Department of Justice’s (DOJ) criminal health care fraud unit investigation into UnitedHealth Group’s alleged practice of recording diagnoses that lead to extra payments to its Medicare Advantage plans.
Former UnitedHealth employees have reportedly been interviewed by prosecutors from the DOJ’s health care fraud unit, the Federal Bureau of Investigation (FBI), and the Department of Health and Human Services’ Office of Inspector General (HHS-OIG), according to the WSJ.
The publication previously reported in May that the DOJ was looking into the company’s Medicare billing practices.
In the latest article, the former workers told the WSJ that they were asked about the company’s alleged practice of encouraging documentation of high-risk diagnoses that lead to extra payments, tests, and procedures to ensure the capture of medical conditions. No one from the DOJ, FBI, or HHS-OIG commented on the WSJ article.
But in response, UnitedHealth Group said in a statement that it stands firmly behind the integrity of its Medicare Advantage business. The company said the WSJ report “represents a continuation of its sustained campaign against Medicare Advantage, relying on incomplete data, a predetermined narrative, and a flawed understanding of how the Medicare Advantage program works.”
Indeed, in the past year the WSJ has published a series of articles that spotlight 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.
UnitedHealth Group said in the statement that independent audits conducted by the Centers for Medicare & Medicaid Services have confirmed the company is “among the most accurate in the industry in our coding practices, demonstrating our commitment to integrity and compliance. Additionally, after more than a decade of a similar Department of Justice challenge to our Medicare Advantage business, the Special Master concluded there was no evidence to support the claims that we were overpaid or engaged in any wrongdoing.”
However, Dr. Naysha Isom told the WSJ that she was interviewed by the DOJ in June about how UnitedHealth trained doctors to use diagnosis codes. Questions centered on what doctors were asked to do regarding diagnosis codes and how they did it, said Dr. Isom, who was a former employee of UnitedHealth’s medical group.
Other former workers told the WSJ that investigators are focused on practices surrounding peripheral artery disease and secondary hyperaldosteronism, as well as the QuantaFlo device, which is used to diagnose the arterial condition.