On July 24, 2025, UnitedHealth Group confirmed in an SEC filing that the Department of Justice has launched both criminal and civil investigations into the company’s Medicare Advantage billing practices, focusing on systematic upcoding fraud that may have generated billions in government …
UnitedHealth GroupUnitedHealthcareDepartment of JusticeCenters for Medicare & Medicaid Serviceshealthcaremedicare-advantageinsurance-fraudregulatory-capturesystematic-corruption
On May 1, 2025, the Department of Justice filed a False Claims Act lawsuit against three of the nation’s largest health insurance companies—Aetna (CVS Health), Humana, and Elevance Health (formerly Anthem)—along with three major insurance brokers—eHealth, GoHealth, and SelectQuote. The …
Department of JusticeAetnaCVS HealthHumanaElevance Health+4 morehealthcaremedicare-advantageinsurance-fraudsystematic-corruptionwhistleblower+1 more
On December 4, 2024, Brian Thompson, CEO of UnitedHealthcare, was shot and killed outside the New York Hilton Midtown in Manhattan. The assassination, allegedly carried out by 26-year-old Luigi Mangione, exposed widespread public anger at the American health insurance industry’s systematic …
Brian ThompsonLuigi MangioneUnitedHealthcareUnitedHealth Grouphealthcareinsurance-fraudsystematic-corruptionhealthcare-violence
On October 31, 2024, the Department of Health and Human Services Office of Inspector General (OIG) released a report estimating that Medicare Advantage insurers received at least $7.5 billion in improper payments in 2023 from Health Risk Assessments (HRAs) that added diagnoses to inflate risk scores …
Department of Health and Human Services Office of Inspector GeneralCenters for Medicare & Medicaid ServicesMedicare Advantage insurershealthcaremedicare-advantageinsurance-fraudsystematic-corruptionregulatory-capture
On August 16, 2024, Humana agreed to pay $90 million to settle the first whistleblower lawsuit alleging systematic fraud in Medicare Part D prescription drug program bidding. The case exposed how Humana maintained “two sets of books”—submitting false financial projections to the Centers …
HumanaCenters for Medicare & Medicaid ServicesDepartment of JusticeSteven Scott (whistleblower)healthcaremedicare-advantageinsurance-fraudsystematic-corruptionwhistleblower
On November 14, 2023, the families of two deceased Medicare Advantage beneficiaries filed a federal class action lawsuit alleging that UnitedHealth Group knowingly uses a faulty artificial intelligence algorithm with a 90% error rate to systematically deny elderly patients coverage for medically …
UnitedHealth GroupNaviHealthUnitedHealthcarehealthcaremedicare-advantageinsurance-fraudartificial-intelligencesystematic-corruption+1 more
On March 13, 2023, ProPublica published an investigation revealing that health insurance giant Cigna used an automated system called PXDX to deny 300,000 claims over two months without doctors examining individual patient files—spending an average of just 1.2 seconds reviewing each case before …
CignaProPublicaHouse Committee on Energy and Commercehealthcareinsurance-fraudsystematic-corruptioninvestigative-journalism
In 2016, a whistleblower who had worked for 12 years at the American Kidney Fund filed a lawsuit alleging that dialysis giants DaVita and Fresenius Medical Care—which together control over 80 percent of the $24.7 billion U.S. dialysis market—operated a years-long kickback scheme where they donated …
DaVitaFresenius Medical CareAmerican Kidney FundDepartment of JusticeFederal Trade Commissionhealthcaredialysissystematic-corruptionmonopolykickbacks+3 more
On October 3, 2008, President George W. Bush signed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) into law as part of the Emergency Economic Stabilization Act (TARP legislation), requiring health insurers to provide mental health and substance use …
George W. BushPaul WellstonePete DomeniciDepartment of LaborEmployee Benefits Security Administration+1 morehealthcaremental-healthinsurance-fraudregulatory-captureenforcement-failure+2 more