The Justice Department is reportedly investigating UnitedHealth Group for fraud related to upcoding — encouraging doctors to diagnose patients with conditions they do not have for profit. The group has been the target of anger regarding the health insurance industry following the killing of UnitedHealthcare CEO Brian Thompson in December.
“The new civil fraud investigation is examining the company’s practices for recording diagnoses that trigger extra payments to its Medicare Advantage plans, including at physician groups the insurance giant owns,” the Wall Street Journal reported Friday.
UnitedHealth shares dropped by 12 percent following the Journal’s report, CNBC reported. They are also facing an antitrust investigation by the DOJ.
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A series of investigations by the Journal found that “Medicare paid UnitedHealth billions of dollars for questionable diagnoses.”
Insurers get a payment from the federal government for patients on a Medicare Advantage plan. The payments increase for certain diagnoses, “creating an incentive to diagnose more diseases,” write the Journal’s Christopher Weaver and Anna Wilde Mathews.
Thompson’s killing elicited an outpour of emotion about the health insurance industry, with patients sharing their stories on social media. The person charged with killing him, Luigi Mangione, has since gained a fawning cult following.
“Doctors said UnitedHealth, based in the Minneapolis area, trained them to document revenue-generating diagnoses, including some they felt were obscure or irrelevant. The company also used software to suggest conditions and paid bonuses for considering the suggestions, among other tactics, according to the doctors,” Weaver and Mathews write.
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Three doctors who were contacted by the DOJ following the Journal’s investigations said “they were questioned about specific diagnoses UnitedHealth promoted for employees to use with patients, incentive arrangements and pressure to add the diagnoses. At least two provided documents, including a contract with a UnitedHealth unit, to the Justice Department,” according to the report.
For example, the company often suggested an obscure condition called secondary hyperaldosteronism — without lab tests. The condition, the Journal found, was “rarely diagnosed by Medicare doctors not working for UnitedHealth.”
The investigators were looking for abuse, according to nurse practitioner Valerie O’Meara, who was interviewed by DOJ attorneys in January.
Mangione is set to appear in New York state court Friday. He is facing murder and terror charges.