Federal authorities are conducting an investigation into UnitedHealth, according to a company filing.
UnitedHealth Group, one of the nation's largest health insurers, is currently under investigation by not one, but two federal bodies: the Securities and Exchange Commission (SEC) and the U.S. Department of Justice (DOJ). The investigations centre around allegations that the company manipulated diagnosis coding to inflate federal payments under the Medicare program.
The DOJ's investigations focus on whether UnitedHealth and its health insurance division improperly gamed Medicare’s risk-rating system. This system adjusts payments based on patient diagnoses, and allegations suggest the company may have inflated diagnoses to receive higher reimbursements.
In response to the investigations, UnitedHealth Group has disclosed that it has received formal requests from the DOJ and is cooperating with both criminal and civil inquiries. The company maintains full confidence in its practices, citing independent audits by the Centers for Medicare & Medicaid Services (CMS) that found its Medicare Advantage billing accuracy to be among the best in the industry.
To increase transparency, UnitedHealth has initiated an independent third-party review of its internal policies and coding protocols. The review is expected to conclude by the end of the third quarter of 2025.
This new development adds pressure to a company already facing a turbulent period. UnitedHealth Group's stock price declined by 1.5 percent in morning trading following the announcement. The company's stock price plunged following a series of reports in The Wall Street Journal about civil and criminal probes into the company.
This is a new development not previously mentioned in the article, adding to an increasingly tumultuous year for UnitedHealth Group. The SEC investigation is a new development not previously mentioned, and the Department of Justice did not immediately respond to a request for comment regarding the SEC investigation.
It's important to note that a court-appointed monitor found no wrongdoing after a decade-long probe into UnitedHealth Group's Medicare Advantage business. However, the WSJ also reported investigations of potential antitrust violations and Medicare billing practices at UnitedHealth Group.
UnitedHealth Group is complying with the requests from the DOJ and is cooperating fully with both the criminal and civil inquiries. The company asserts it is innocent based on prior audit findings.
This news comes after a year that has been challenging for UnitedHealth Group. Last year, UnitedHealthcare CEO Brian Thompson was fatally shot in New York, sparking a national conversation about frustrations with healthcare companies. Additionally, the company was the worst performer on the Dow Jones Industrial Average during the first half of 2025. The company's CEO abruptly left the company in May.
As the investigations continue, UnitedHealth Group will need to navigate these challenges and work to restore public trust in its practices. The company has emphasised its commitment to transparency and cooperation throughout the process.
- The UnitedHealth Group, amidst investigations by two federal bodies, is also under scrutiny by the Securities and Exchange Commission (SEC).
- In addition to improving transparency, UnitedHealth Group has initiated an independent third-party review of its Medicare Advantage billing practices, following allegations of manipulating diagnosis coding for higher reimbursements.
- Despite the current turmoil in its business, UnitedHealth Group faced additional challenges last year, including the sudden departures of its CEO and the company being the worst performer on the Dow Jones Industrial Average during the first half of 2025.
