Report: DOJ questioning doctors linked to possible Medicare fraud at UnitedHealth
A new report claims the U.S. Department of Justice (DOJ) has been actively interviewing former UnitedHealth employees as part of a criminal probe into possible Medicare fraud at the insurer.
According to the Wall Street Journal, sources familiar with the investigation say federal police have been looking into claims that UnitedHealth upcoded medical claims, deploying its own doctors and nurses to record patient diagnoses and treatment plans that would earn more reimbursement from the Centers for Medicare & Medicaid Services (CMS).
According to the report, the DOJ is working with the Federal Bureau of Investigation (FBI) and the HHS Office of Inspector General (OIG) to look into what they see as suspicious activity, possibly signaling fraud on behalf of UnitedHealth and its clinicians.
Doctors have already been interviewed, with prosecutors probing the basis for these lucrative diagnoses, the report said. Questions include details about the training the physicians received regarding these patient cases, as well as the validity of testing associated with the alleged upcoding.
Incidents of fraud are linked to Medicare Advantage plans, which are run by UnitedHealth but benefit from government subsidies and reimbursement for patient care delivery.
To date, no charges have been filed. In a statement to the outlet, the insurer said it welcomes an audit of its “policies and practices” and denies it’s done anything illegal.
The investigation was first revealed in a May exclusive. At the time, the company denied any knowledge of a DOJ investigation and accused the Journal of "irresponsible" reporting.
The full story from the Wall Street Journal is available at the link below.
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.