May 29, 2025

UnitedHealth Faces Investigation Over Possible Medicare Fraud

The U.S. government is looking into UnitedHealth Group, a major health insurance company, to see if it broke rules related to Medicare, a program that provides health coverage for people over 65 and some younger people with disabilities.

What’s the Issue?
Investigators from the U.S. Department of Justice are checking if UnitedHealth overcharged Medicare by making patients seem sicker than they actually were. This practice, called "upcoding," can lead to the government paying more money to insurance companies than it should. The investigation is happening in two parts: one is a civil case (about money and rules) and the other is a criminal case (which could lead to bigger penalties if laws were broken).

Why Does This Matter?
UnitedHealth is one of the biggest companies that runs Medicare Advantage plans, a type of private insurance option for Medicare patients. These plans cover millions of people, and the government pays companies like UnitedHealth based on how sick patients are. If a company says patients are sicker than they really are, it gets extra money—potentially billions of dollars over time.

What’s Been Happening?

• The Justice Department has been asking UnitedHealth for records, like patient charts and billing data, to check for signs of fraud.
• They’re looking at whether UnitedHealth wrongly added serious health conditions to patient records to boost payments.
• This isn’t the first time—other insurance companies have faced similar accusations, and some have paid big fines to settle.

UnitedHealth’s Response
UnitedHealth says it follows all the rules and is working with the government to explain its practices. The company insists it bills Medicare fairly and that its focus is on helping patients get better care.

What’s Next?
The investigation is ongoing, and no final decisions have been made. If UnitedHealth is found guilty, it could face fines, have to repay money, or even face criminal charges. This case could also affect how other insurance companies handle Medicare in the future.

Why You Should Care
Medicare is funded by taxpayer money, so any fraud means higher costs for everyone. Plus, it could impact the quality of care for millions of older Americans who rely on these plans.