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 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 February 27, 2024, the Wall Street Journal reported that the Department of Justice launched a major antitrust investigation into UnitedHealth Group, focusing on whether the company’s vertical integration strategy—particularly Optum’s acquisition of physician practices—creates …
Department of JusticeUnitedHealth GroupUnitedHealthcareOptumhealthcaremedicare-advantageantitrustvertical-integrationregulatory-capture+1 more
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