Senate Report: UnitedHealth was aggressive in seeking higher Medicare Advantage payments

Sen. Chuck Grassley’s investigation into UnitedHealth Group’s business practices alleges that the company did pressure providers to upcode patient diagnoses, with the purpose of earning higher payouts for its Medicare Advantage plans.

The report from a Senate Judiciary Committee was obtained by the Wall Street Journal, which published its findings. The conclusions were based on more than 50,000 documents—including medical claims—that the insurer sent to lawmakers to review as part of their investigation. 

Grassley had requested the information in February 2025, after a story broke that UnitedHealth was being investigated by the U.S. Department of Justice (DOJ) over an excessive number of patients on its Medicare Advantage plans being diagnosed with chronic conditions that earn more risk-adjusted subsidies from the Centers for Medicare & Medicaid Services (CMS). 

The Wall Street Journal was the first to break that news as part of multiple reports on possible corruption at UnitedHealth. In future stories, the outlet would go on to claim the DOJ had interviewed providers as part of the investigation, which the company later confirmed was occurring. 

UnitedHealth has maintained its innocence and said it’s complied with all federal regulations. Notably, no formal lawsuit or criminal charges have been filed against the organization or anyone in leadership. 

This latest report from the Wall Street Journal indicates that the U.S. Senate stopped short of accusing UnitedHealth of wrongdoing, but did think there was a trend showing the company’s providers leaned toward more serious patient diagnoses for its Medicare Advantage members.

"UnitedHealth Group has identified opportunities and strategies to increase its capture of untapped risk score garnering diagnoses and has used its robust provider workforce to implement those strategies," the Senate report, as published by the Wall Street Journal, reads. "Other Medicare Advantage organizations contract with UHG for these coding opportunity insights."

The Senate committee also noted that as the Centers for Medicare & Medicaid Services changed policy on what diagnostic codes would earn enhanced payments based on a patient's health, UnitedHealth was able to find new ways to make up any losses. 

The Wall Street Journal noted that the insurer has the necessary staff and artificial intelligence technology at the ready to make risk assessments and navigate the changing regulatory landscape, something they could deploy to to keep their Medicare Advantage members profitable without altering patient care.

In a statement, UnitedHealth rejected the analysis of the Senate and reaffirmed its compliance with all CMS regulations. 

"We remain focused on continuing to deliver lower costs, better access and higher quality care for the people we serve, including those in Medicare Advantage," a spokesperson stated. 

For more, read the Wall Street Journal’s coverage at the link below.