A U.S. Senate committee report has raised serious concerns regarding UnitedHealth Group’s Medicare Advantage coding practices, asserting that the health insurer employed aggressive risk-adjustment coding tactics to secure higher government reimbursements for its Medicare patients. As a direct response to the allegations, stocks for UnitedHealth Group saw a decline of approximately 1.6%, trading at $338.21 on the morning of the report’s release.
The Medicare program, which caters primarily to individuals aged 65 and older and those with disabilities, allows private health plans like Medicare Advantage to receive a fixed payment for each enrolled patient. However, these payments can increase based on the patients’ health status, incentivizing insurers to accurately report patient diagnoses. The committee’s findings indicated that UnitedHealth Group submitted more diagnoses and diagnostic codes than any other organization in the Medicare Advantage sector, resulting in elevated payments based on their patients’ health conditions.
Senator Chuck Grassley, who chairs the Senate judiciary committee, emphasized that the investigation revealed evidence suggesting UnitedHealth had transformed risk adjustment into a significant profit-generating strategy that deviated from the program’s intended purpose. He described the findings as a troubling indication of how the company manipulates coding practices for financial gain.
In response, a UnitedHealth spokesperson expressed their disagreement with the report’s conclusions, asserting that the company’s coding practices and the associated HouseCalls program adhere to government regulatory requirements. The spokesperson also pointed out that UnitedHealth has consistently demonstrated compliance with regulatory standards through past government audits.
The report is grounded in an extensive review of over 50,000 pages of internal UnitedHealth documents, including training materials, policies, and software documentation. Notably, this investigation comes on the heels of previous reports by The Wall Street Journal regarding a probe by the U.S. Department of Justice into UnitedHealth’s Medicare operations. The company confirmed its cooperation with ongoing criminal and civil investigations initiated by federal authorities.
As the situation continues to unfold, the implications of the Senate committee’s findings could significantly impact UnitedHealth Group’s operations and its standing in the health insurance market.
