UnitedHealth Group seems to be in trouble. The insurance giant is facing a criminal and civil investigation from the Department of Justice, the company disclosed on Thursday.
“The Company has now begun complying with formal criminal and civil requests from the Department. The Company has full confidence in its practices and is committed to working cooperatively with the Department throughout this process,” UnitedHealth said.
UnitedHealth Group, headquartered in Eden Prairie, Minnesota, is one of the largest and most influential healthcare companies in the United States. It operates primarily through two divisions: UnitedHealthcare and Optum.
READ: UnitedHealth Group under criminal investigation by DOJ for Medicare fraud (May 15, 2025)
UnitedHealthcare provides a wide range of health insurance products and services, covering millions of Americans across employer-sponsored plans, Medicare, Medicaid, and individual plans. Optum focuses on healthcare delivery, pharmacy care services, data analytics, and technology-driven solutions aimed at improving healthcare outcomes and efficiency.
In 2024, UnitedHealth Group reported revenues surpassing $400 billion and served over 148 million people, reflecting its broad reach and critical role in the U.S. healthcare system. The company emphasizes value-based care models designed to improve patient health while controlling costs, positioning itself as a leader in integrating technology and healthcare services.
ABC News reports that the company in an SEC filing said it was complying with the requests from the DOJ. UnitedHealth said it reached out “proactively” to the DOJ after media reports about a probe into its Medicare practices.
“The Company is committed to maintaining the integrity of its business practices and serving as reliable stewards of American tax dollars,” UnitedHealth said.
The Wall Street Journal (WSJ) reported in May that the DOJ’s healthcare-fraud unit was investigating possible Medicare fraud at the company, adding to investigations of potential antitrust violations and its Medicare billing practices.
The probe centers on whether UnitedHealth inflated Medicare reimbursements by encouraging healthcare providers to assign inaccurate or unsupported diagnoses. Specifically, the DOJ is scrutinizing in-home health risk assessments and chart reviews performed by clinicians affiliated with UnitedHealth, which allegedly led to exaggerated risk scores. These inflated scores translate to higher payments from Medicare, raising concerns about potential healthcare fraud.
READ: FTC to bring lawsuit against CVS, Cigna, and UnitedHealth Group (January 16, 2025)
UnitedHealth has acknowledged the investigation and expressed its cooperation with authorities, maintaining that its billing practices comply with all legal and regulatory standards.
Despite UnitedHealth’s assurances, the investigation has increased regulatory and public scrutiny of the company’s operations. The firm has initiated independent audits to verify the accuracy of its diagnosis-recording procedures and ensure compliance with federal guidelines. The outcome of this criminal inquiry could have serious implications for UnitedHealth, including potential financial penalties and reputational damage.
As the investigation unfolds, regulators and industry observers will closely watch how UnitedHealth addresses these allegations and adapts its practices to meet legal and ethical standards.
The outcome of the investigation will likely impact not only UnitedHealth’s reputation and finances but could also influence broader industry reforms aimed at preventing fraud and ensuring taxpayer dollars are used responsibly.