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UnitedHealth Group has said it has not been notified by the Department of Justice of a reported criminal investigation.
The Wall Street Journal reported on Wednesday that the firm is facing a DOJ investigation for possible Medicare fraud, according to anonymous sources. The newspaper said that the investigation has been active since at least last summer, and is being led by the health care fraud unit of the DOJ's criminal division.
Responding to the report, UnitedHealth Group said in a statement on Wednesday: "We have not been notified by the Department of Justice of the supposed criminal investigation reported, without official attribution, in the Wall Street Journal today.
"The WSJ's reporting is deeply irresponsible, as even it admits that the 'exact nature of the potential criminal allegations is unclear.' We stand by the integrity of our Medicare Advantage program."
Newsweek has contacted UnitedHealth and the DOJ outside of regular working hours for comment.
Why It Matters
UnitedHealthcare is the nation's largest provider of Medicare Advantage plans, with more than eight million customers, according to the Associated Press. These are privatized versions of the federal government program, mostly for people aged 65 and older.
What To Know
The DOJ's reported probe adds to a list of government inquiries into UnitedHealth, including into potential antitrust violations and a civil investigation of its Medicare billing practices, according to The Wall Street Journal.
The newspaper reported on a civil fraud investigation into the company in February. UnitedHealth described the report as "misinformation," adding that it was not aware of a new probe.
The Journal reported that the case—brought by a former employee in 2011 and joined by the government in 2017—concerned allegations that UnitedHealth submitted $2 billion worth of diagnoses recorded by doctors that its reviewers determined were not supported by patients' medical charts.
In March, a court-appointed special master recommended that a judge dismiss the case after concluding the government had not presented sufficient evidence that patient diagnoses submitted for payment were not accurate. The judge has not yet ruled on the recommendation.
UnitedHealth has faced a series of challenges over the past year, including the killing of Brian Thompson, the head of its insurance unit.
During the company's first earnings call after Thompson's death, CEO Andrew Witty said health care in the U.S. needs to be "less confusing, less complex and less costly."
The company's technology unit, Change Healthcare, also faced a cybersecurity attack on its systems last year that disrupted payments to health providers for months.
Why Did CEO Andrew Witty Step Down?
On Tuesday, UnitedHealth announced that Witty was stepping down for personal reasons and would be replaced by chairman Stephen Hemsley. The company said that Hemsley will remain chairman of the company's board of directors and that Witty would serve as a senior adviser to Hemsley.
"Leading the people of UnitedHealth Group has been a tremendous honor as they work every day to improve the health system, and they will continue to inspire me," Witty said in a statement.
The company also suspended its full-year financial outlook due to higher-than-expected medical costs.
What People Are Saying
UnitedHealth said in a statement on Tuesday: "The company suspended its 2025 outlook as care activity continued to accelerate while also broadening to more types of benefit offerings than seen in the first quarter, and the medical costs of many Medicare Advantage beneficiaries new to UnitedHealthcare remained higher than expected."
Republican Representative Greg Murphy said on Fox Business in March: "I'll pick out the worst offender is United which is literally charging $1,000 more per enrollee than anyone else and they up-code them. You take a stone-cold healthy person and they suddenly have 15 things wrong with them, then on the backside, they don't pay the people they should... It's not necessarily fraud because some of this is legal but they're pushing the boundaries, and it's really immoral in fact."
What Happens Next
It is not clear what the potential criminal allegations against UnitedHealth are, according to the Journal. It is also not yet known whether the DOJ will file any charges.
Update and correction 5/15/25, 5:15 a.m. ET: This article has been updated with additional information and corrections to the spelling of Andrew Witty and Stephen Hemsley.
About the writer
Khaleda Rahman is Newsweek's National Correspondent based in London, UK. Her focus is reporting on education and national news. Khaleda ... Read more