UnitedHealth Group is under scrutiny from the U.S. Department of Justice for alleged fraudulent billing practices related to Medicare Advantage plans. The investigation, which is civil rather than criminal, centers on claims that the insurer is inflating patient diagnoses to receive higher payments. This follows a prior report highlighting significant increases in diagnoses among patients enrolled in Medicare Advantage. Physicians indicated they felt pressured by UnitedHealth to document certain conditions that seemed unnecessary, raising ethical questions about the company's practices and their impact on healthcare costs.
The DOJ is concerned that UnitedHealth is recording patient diagnoses that generate additional payments to its Medicare Advantage plans.
Doctors reported that UnitedHealth trained them to document revenue-generating diagnoses, using software to suggest conditions and offering bonuses for following these suggestions.
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