UnitedHealth Group has confirmed that the U.S. Department of Justice is conducting both criminal and civil investigations into its Medicare Advantage operations, according to BestWire.
The company stated it is cooperating with federal authorities and has submitted information in response to official requests.
UnitedHealth said it proactively contacted the DOJ after reviewing media reports that first surfaced in May. At the time, the company denied knowledge of any criminal probe and criticized The Wall Street Journal’s reporting as “deeply troubling.”
Days later, UnitedHealth publicly rejected claims it defrauded Medicare or deliberately restricted care to reduce costs.
Despite the inquiries, UnitedHealth maintains that its Medicare practices comply with federal rules.
In statement, the company pointed to independent audits by the Centers for Medicare & Medicaid Services, which it says validate its operational accuracy.
It also referenced a prior civil case brought by the DOJ, where a court-appointed special master reportedly found no evidence of misconduct after a lengthy review.
UnitedHealth has initiated an internal review by a third-party firm to examine its policies, performance metrics for risk coding, managed care procedures, and pharmacy services oversight.
The DOJ’s broader scrutiny of the Medicare Advantage sector includes a separate case filed in early May in Massachusetts federal court.
That lawsuit alleges three insurers—names undisclosed—engaged in a kickback scheme to push large brokers to steer clients toward their plans.
UnitedHealth has not been publicly named in that specific lawsuit, but the investigations mark a growing federal focus on the business practices behind Medicare Advantage enrollment and reimbursement.
