US justice department opens civil fraud investigation into UnitedHealthcare | US news

SS; If Brian Thompson is found to have committed fraud against the Medicare Advantage program and DOGE finds it how will that affect the Mangione case and would it make DOGE more popular with the public?

The US Department of Justice is reportedly investigating the insurance giant UnitedHealthcare for its Medicare billing practices.

The federal government is examining whether UnitedHealthcare is using patient diagnoses to illegally increase the lump sum monthly payments received through the Medicare Advantage program, according to a report in the Wall Street Journal.

Although it is best known for its insurance operations, UnitedHealthcare is one of the largest corporations in the world with a $457bn market capitalization. Its businesses touch health technology, pharmacy benefits and physician practices.

The company is so large that one industry analyst estimated 5% of US gross domestic product flowed through its infrastructure each day. It is the largest employer of doctors in the US with more than 90,000 physicians in 2023, or nearly one in 10 American doctors.

According to the report, the justice department is now conducting a civil fraud investigation.

Medicare is a public health insurance program for the elderly and disabled that covers more than 65 million Americans. About half of those beneficiaries use Medicare Advantage plans – a program started by Congress to allow private insurers to manage beneficiaries’ care.

At the time it was created, during the George W Bush administration, supporters argued private corporations would be able to more efficiently provide the same services as government and save taxpayers money.