An exclusive report by the Wall Street Journal (WSJ) claimed that the Department of Justice is investigating UnitedHealth Group over allegations that its Medicare Advantage business practices may have led to criminal Medicare fraud.

The report states that the criminal investigation has been ongoing since at least last summer. However, the exact scope is, so far, unclear.

The WSJ reported in February that UnitedHealth was under a civil probe for its use of its Medicare Advantage business practices. That civil investigation examined the company’s practice of recording diagnoses that trigger additional payments from Medicare, which the WSJ has extensively reported on.

According to a December 2024 investigation by the WSJ, UnitedHealth-employed doctors made more obscure, and lucrative, diagnoses after joining UnitedHealth’s Medicare Advantage plans, which some doctors said was the result of coercion and training.

Another WSJ report claimed that UnitedHealth pocketed billions in federal payments by adding diagnoses to patients’ records that were not treated by doctors.

UnitedHealth is the largest provider of Medicare Advantage plans, which are offered by private insurance companies that are approved by Medicare.

UnitedHealth in crisis

The company’s stock price has been in steep decline since last month, losing around half of its total value, estimated at $288 billion, prompting concerns that it might be delisted. The company’s stock dropped an additional 8% in after-hours trading following the WSJ’s report on the DOJ’s criminal investigation.

UnitedHealth responded by stating that the reporting was “deeply irresponsible,” noting that the company itself had not been informed of a criminal investigation. That response echoed UnitedHealth’s reply to the WSJ’s February reporting on the DOJ’s civil investigation, which it also said it was blindsided by.

“We stand by the integrity of our Medicare Advantage program,” it said in its most recent statement.

Last week, the healthcare giant’s CEO Andrew Witty abruptly stepped down. Stephen Hemsley, who ran the company from 2006 to 2017, will replace him.

Its previous CEO Brian Thompson attracted national attention when he was killed outside a Manhattan hotel in December 2024. That year, the company also suffered from rapidly rising healthcare costs and a massive cyberattack.

A potential criminal investigation into UnitedHealth aligns with recently announced DOJ enforcement priorities, which lists Medicare fraud and procurement fraud as primary concerns, amid other claims enforceable under the False Claims Act/Anti-Kickback Law.

Earlier this month, the DOJ sued three US health insurance companies, accusing them of paying brokers hundreds of millions of dollars in kickbacks to induce patients to utilize the Medicare Advantage program.

• We recently discussed false claims in healthcare, and related compliance challenges, in depth with two veteran attorneys in the field.