Report: DOJ investigating business practices of UnitedHealth’s Optum Rx
As revealed in multiple media reports, UnitedHealth Group is being investigated by the U.S. Department of Justice (DOJ), with prosecutors looking into possible instances of Medicare Advantage upcoding.
Those claims came from multiple reports by the Wall Street Journal, which UnitedHealth initially called “irresponsible” and denied. It later confirmed the investigation in a filing with the U.S. Securities and Exchange Commission.
As to the specifics: Allegedly, the company may have pressured physicians into making more complicated diagnoses for patients covered by Medicare Advantage, which in turn means those patients earn more subsidies from the Centers for Medicare & Medicaid Services, which are then passed onto doctors.
However, there have been no formal accusations or charges related to the investigation. UnitedHealth maintains that it’s passed all audits and has nothing to hide.
New report claims PBM involved
This week, Bloomberg released a report saying the DOJ may also be looking into the “prescription management services” of the insurer—including the business practices of Optum Rx, a pharmacy benefit manager (PBM) and subsidiary of UnitedHealth.
Bloomberg cites “people familiar with the matter” as the basis for its coverage.
The outlet said this could be related to the previous investigation over Medicare Advantage billing practices and the associated physician reimbursement. Notably, the Wall Street Journal said physicians working with UnitedHealth had been interviewed as part of the DOJ investigation.
The Bloomberg report doesn’t add many new details. The outlet added that the existence of a probe does not mean the insurer or anyone else will be formally accused of wrongdoing.
The DOJ has never publicly commented on the media reports. The allegations of an ongoing investigation date back to the initial Wall Street Journal report in February.
For more, read the full report from Bloomberg by clicking here.
Chad is an award-winning writer and editor with over 15 years of experience working in media. He has a decade-long professional background in healthcare, working as a writer and in public relations.