Federal investigation has been initiated against UnitedHealth, focusing on their Medicare business proceedings.
UnitedHealth Group, one of the nation's largest health insurance providers, is currently under investigation by the U.S. Department of Justice (DOJ) for potential civil and criminal misconduct related to its Medicare Advantage (MA) diagnoses and billing practices.
The DOJ's investigation, which has been ongoing since earlier this year, focuses on UnitedHealth's recording of diagnoses for its Medicare Advantage plans. The probe is spearheaded by the DOJ's healthcare-fraud unit, with a particular focus on whether the company’s diagnosis coding practices improperly increased payment from the government.
UnitedHealth Group, which operates one of the nation's largest health insurance and pharmacy benefits management businesses, has begun cooperating with the DOJ by complying with formal criminal and civil requests. The company proactively reached out to the DOJ after media reports surfaced about the probe, emphasizing its commitment to cooperating fully throughout the process.
The DOJ investigation covers potential fraudulent billing related to how UnitedHealth records diagnoses for Medicare Advantage plans, which are private alternatives to traditional Medicare primarily serving those 65 and older. UnitedHealth Group's UnitedHealthcare business covers over 8 million people, making it the nation's biggest MA provider.
The investigation appears part of broader DOJ scrutiny, which also includes potential antitrust concerns unrelated to billing. UnitedHealth has stated it has full confidence in its practices and referenced a prior decade-long court-monitored review into its Medicare Advantage business that found no wrongdoing.
UnitedHealth Group's stock price has been affected by the investigation, with a primary decrease since December. The company reported over $400 billion in revenue last year, making it the third-largest company in the Fortune 500. However, the company has faced stock price declines and leadership changes earlier in 2025, partly amid these heightened regulatory pressures and other unrelated events involving its CEO.
The company is scheduled to report its second-quarter results next Tuesday. The stock price fell another 2% on Thursday morning, representing a 54% drop from its all-time high. In April, UnitedHealth's shares plunged after the company cut its forecast due to a surge in health care use.
The investigation is not the only challenge UnitedHealth Group is facing. A federal criminal health care-fraud unit is also investigating how UnitedHealth Group used doctors and nurses to gather diagnoses that bolster payments, according to The Wall Street Journal's report earlier this month.
In other news, former CEO Andrew Witty resigned in May, and the company withdrew its forecast. UnitedHealth Group Inc. is currently cooperating with federal investigators in both criminal and civil investigations.
[1] UnitedHealth Group SEC Filing, July 24, 2025. [2] The Wall Street Journal, various reports from February to present.
- The UnitedHealth Group's cooperation with the DOJ includes addressing concerns about its Medicare Advantage diagnoses and billing practices, which are being investigated by the DOJ's healthcare-fraud unit for potential civil and criminal misconduct.
- The current investigation into UnitedHealth Group's Medicare Advantage practices overlaps with the DOJ's broader scrutiny of the company, which includes potential antitrust concerns and allegations of improperly increasing payments from the government through diagnosis coding practices.
- The ongoing DOJ investigation into UnitedHealth Group's Medicare Advantage practices and financial dealings has contributed to a decline in the stock price of the health insurance giant, which ranks among the Fortune 500's top three companies by revenue and operates a significant health-and-wellness and medical-conditions focused business.
