DOJ questions ex-UnitedHealth doctors in probe into Medicare fraud: report

Core Viewpoint - The Department of Justice is investigating UnitedHealth for allegedly encouraging staff to make specific diagnoses that would lead to higher Medicare payments, particularly under the Medicare Advantage program [1][6]. Investigation Details - The investigation involves inquiries from the Justice Department, FBI, and Health and Human Services regarding patient testing, diagnostic procedures, and the process of sending nurses to patients' homes [2]. - Former employees reported that investigators asked about training related to making diagnoses and the methods used to contact patients for testing [4][8]. Company Response - UnitedHealth maintains that it supports the integrity of its Medicare Advantage business and welcomes regular reviews of its practices [3]. - The company criticized the Wall Street Journal for what it perceives as a biased narrative against Medicare Advantage, claiming reliance on incomplete data [3][4]. Diagnostic Practices - Former doctors indicated that the focus was on coding practices, specifically how diagnosis codes are submitted to Medicare for payments [5]. - Investigators inquired about bonuses for doctors reviewing potential diagnoses suggested by UnitedHealth [7]. Software and Tools - The investigation also looked into the "diagnosis cart" feature of UnitedHealth's software, which suggests potential medical conditions to nurses [11]. - UnitedHealth argues that its diagnostic practices are aimed at early disease detection and plans to implement independent third-party oversight for these practices [8]. Previous Investigations - A separate decade-long effort by the Justice Department to recover alleged Medicare overpayments from UnitedHealth was unsuccessful [10].