Healthcare Uncovered, WENDELL POTTER, FEB 21, 2025

UnitedHealth Group, the largest U.S. health insurer, is once again under federal scrutiny—this time for potentially fraudulent Medicare billing practices. As The Wall Street Journal reported, the Department of Justice (DOJ) has launched a civil fraud investigation into the company’s use of diagnoses that trigger higher Medicare Advantage payments. This is just the latest chapter in a long-running saga of how private insurers have exploited the Medicare Advantage system to inflate their profits—at a massive cost to taxpayers.

Here is what I said this morning on CNBC about the DOJ’s probe into UnitedHealth:

I think what we’re seeing here is that the Trump administration has really good evidence that a lot of taxpayer dollars can be saved by cracking down on the practices of the insurance industry — on companies like UnitedHealth Group that own and operate Medicare Advantage plans. 

[Medicare Advantage] has been a huge cash cow for these companies for several years.

The Medicare Advantage program was sold to the public as a way to save money by allowing private insurers to manage Medicare benefits more efficiently. Instead, it has turned into a $140 billion overpayment bonanza for insurers. The system incentivizes companies like UnitedHealth to game the billing process, ensuring they get paid more by documenting additional—and often questionable—diagnoses for their enrollees.

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