DOJ launches civil and criminal investigation into UnitedHealth Medicare billing practices

The U.S. Department of Justice is conducting both civil and criminal investigations into the Medicare billing practices of UnitedHealth Group.

(NBC) – The U.S. Department of Justice is conducting both civil and criminal investigations into the Medicare billing practices of UnitedHealth Group, one of the largest health insurance providers in the country.

Health care analyst Ron Howrigon, a former insurance executive who now works on the other side of the system—advocating for providers in negotiations with insurers—says the stakes are high.

“It’s extremely serious,” Howrigon said. “Either side loses this case, they’re probably going to appeal it.”

The probe, first reported by The Wall Street Journal, comes amid growing scrutiny of Medicare Advantage providers. UnitedHealth initially said it had not been informed of any investigation but has since acknowledged the DOJ probe and says it is cooperating with federal officials.

However, critics say the company has yet to fully own up to potential wrongdoing. “Really, all I’ve seen them do today is acknowledge the investigation. I’ve yet to see United really come out and say, ‘Hey, we’ve been wrong,’” Howrigon noted.

Last year, KARE 11 Investigates reported on AI-driven denials of Medicare Advantage claims by UnitedHealth, which left many patients without necessary coverage. State officials told reporter Lauren Leamanczyk at the time that those decisions are hard to challenge. The concern now spans broader billing practices, with questions raised about AI use, claim denials, and potential overbilling that could be costing taxpayers. “Whether it’s using AI to deny claims that shouldn’t be denied, or overbilling Medicare — it’s adding cost to the healthcare delivery system,” said Howrigon.

The investigation is expected to take time and could result in significant fines, further damaging public perception of the insurance giant.