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UnitedHealth Group is facing new scrutiny after The Wall Street Journal reported that the Department of Justice is investigating the company for potential criminal healthcare fraud. The focus? Its highly profitable Medicare Advantage program.
While the exact allegations are unclear, the Journal says the DOJ's criminal division-specifically its healthcare fraud unit-has been looking into the company's practices since mid-2024.UnitedHealth, however, says it hasn't been ed by the government. In a sharp rebuttal, the company called the report "deeply irresponsible" and stood by its Medicare Advantage operations.
Lawsuits, AI Denials, and a CEO Exit: Why UnitedHealth Is Under Pressure
The investigation news comes at a turbulent time for UnitedHealth. Earlier this year, the company was sued in a class-action case alleging it used artificial intelligence instead of doctors to deny Medicare Advantage claims-sometimes with deadly consequences, according to plaintiffs.
There's also an ongoing civil Medicare fraud case tied to accusations that UnitedHealth submitted inflated diagnoses not backed by patient records. That case, first filed by a whistleblower and later ed by the government, could have involved up to $2 billion in questionable billing. A special master recommended dismissal, citing lack of evidence, but the final call is still in the judge's hands.
And then there's the leadership shakeup. CEO Andrew Witty announced he's stepping down, with former CEO Stephen Hemsley returning to lead the company. The official word is that Witty is leaving for personal reasons-but the timing has raised eyebrows.
Meanwhile, UnitedHealth has paused its 2025 financial outlook, blaming higher-than-expected medical costs in its Medicare Advantage business. According to Reuters, investor confidence took a hit, with company shares plunging 16%-their lowest level in five years.
On top of all this, the company is still battling a DOJ lawsuit over its proposed merger with Amedisys, which regulators say could give it an unfair share of the home health care market.
So far, the DOJ hasn't confirmed the reported investigation. Still, the combination of lawsuits, federal scrutiny, and leadership turnover suggests that the nation's biggest Medicare Advantage provider may be facing a serious reckoning.