• The DOJ is investigating UnitedHealthcare for allegedly inflating Medicare Advantage payments by manipulating patient diagnoses.
• Medicare Advantage cost taxpayers $83 billion more in 2024, with patients often facing delays due to restrictive policies.
• UnitedHealthcare denies the allegations, but its practices and role in public healthcare continue to face scrutiny.

The Department of Justice (DOJ) has launched a civil fraud investigation into UnitedHealthcare, a giant in the insurance industry, over its Medicare Advantage billing practices. This probe scrutinizes whether the company manipulated patient diagnoses to inflate government payments through the Medicare Advantage program, according to a recent Wall Street Journal report.

Medicare Advantage Costs Under Fire

Medicare Advantage, a private-insurance alternative to traditional Medicare, was intended to streamline care and reduce costs. However, studies, like one from the Medicare Payment Advisory Commission, show taxpayers paid a shocking $83 billion more for Medicare Advantage in 2024 alone. Many patients complain about restrictive policies, such as prior authorizations that delay treatment (learn more here).

UnitedHealthcare: A Corporate Behemoth

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Best known for insurance, UnitedHealthcare controls vast sections of the healthcare market. With over 90,000 employed physicians, it is the largest employer of doctors in America (source). This influence is so massive that 5% of the U.S. GDP flows through its systems daily (read more).

The company has faced scrutiny before. A 2024 data breach exposed 85 million patient records, and critics labeled it “healthcare’s Deepwater Horizon moment.”

UnitedHealthcare Denies Allegations

A spokesperson for UnitedHealthcare dismissed the allegations as “outrageous and false”, claiming government reviews regularly confirm their compliance. Additionally, they accused the Wall Street Journal of perpetuating misinformation to defend an outdated system.

Public sentiment remains harsh. Many Americans express frustration over care denials and high costs. Following the murder of UnitedHealthcare CEO Brian Thompson, public reactions ranged from apathy to derision.

What’s Next for UnitedHealthcare?

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As the DOJ and the Department of Health and Human Services investigate, questions about the ethics and efficiency of Medicare Advantage programs intensify. This inquiry comes as part of broader concerns about private involvement in public healthcare.

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