Core Viewpoint - The U.S. Senate committee has found that UnitedHealth (UNH.US) employed "aggressive strategies" to collect diagnostic information from its Medicare Advantage members to increase payments, turning risk adjustment into a business, which was not its original intent [1] Group 1: Investigation Findings - A new report based on a review of 50,000 pages of records submitted by UnitedHealth to the U.S. Senate Judiciary Committee revealed that the company systematically added diagnostic information to patient records to secure billions of dollars in additional federal funding [1] - Some of the added diagnoses were questioned for their accuracy, and many patients appeared not to have received treatment for these newly added conditions [1] Group 2: Ongoing Investigations - UnitedHealth is facing multiple investigations regarding its business practices, including civil and criminal investigations disclosed by the Department of Justice in July [1] Group 3: Company Response - A spokesperson for UnitedHealth disagreed with the Senate report's characterization, stating that the company complies with Medicare requirements and has performed well in diagnostic audits [1] - The spokesperson emphasized the company's commitment to providing lower-cost, more convenient, and higher-quality healthcare services to its Medicare Advantage population [1]

Core Viewpoint - The case highlights a significant breach of trust within the insurance industry, where an employee of China Life Property Insurance Co., Ltd. engaged in fraudulent activities, leading to substantial financial losses for the company [1][9]. Group 1: Fraudulent Activities - The employee, Hu, assisted an external accomplice, Jiang, in submitting false insurance claims, resulting in a total fraud amount of 1.229852 million yuan (approximately 122.99 million) [1][13]. - Hu received a total of 540,000 yuan (approximately 54 million) as kickbacks for facilitating the fraudulent claims [1][5]. Group 2: Legal Proceedings - The case underwent multiple legal processes, including a first-instance trial, an appeal, and a final judgment by the Yichun Intermediate People's Court, which sentenced Hu to five years in prison for fraud [1][9]. - The court determined that Hu's actions constituted a significant role in the fraud, leading to a conviction for fraud rather than bribery, despite his defense arguing otherwise [11][13]. Group 3: Internal Control Failures - The case revealed critical failures in the internal control mechanisms of China Life Property Insurance, as Hu, despite recognizing the fraudulent nature of the claims, chose to proceed with the submission [8][12]. - The insurance company's risk control system, which should have acted as a firewall against such fraud, was compromised due to Hu's negligence and unethical behavior [8][12].