UnitedHealth Says It’s Cooperating With DOJ Over Medicare Practices

UnitedHealth said it proactively contacted the Justice Department after reports of the investigations surfaced and subsequently received the department’s requests. “The company has a long record of responsible conduct and effective compliance,” UnitedHealth said in the filing.

The latest development compounds a bruising year for the country’s largest health insurer. Earlier in 2025, UnitedHealth scrapped its financial outlook and replaced its chief executive officer after Medicare costs ran higher than expected, according to Bloomberg. The upheaval followed the fatal shooting of a senior executive months earlier, an event that intensified scrutiny of industry practices.

Medicare at the Core — and Under the Microscope

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Medicare sits at the heart of UnitedHealth’s growth plan. The company not only sells Medicare Advantage plans to seniors but also operates a sprawling clinic and home-care network through its Optum division. It is the biggest private Medicare Advantage player, serving more than 8 million members. As the program expanded over the past decade, regulators and whistleblowers have accused multiple insurers of overstating patient illness severity to increase payments — allegations that have triggered industrywide investigations and settlements, according to Bloomberg.

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Insurers are reimbursed more for treating sicker patients, with payments tied to diagnosis codes. UnitedHealth has spent more than a decade contesting one Justice Department lawsuit that began with a whistleblower complaint and recently secured a favorable ruling in that specific case, per Bloomberg. Meanwhile, federal officials at the Centers for Medicare & Medicaid Services have revised the “risk model” that sets those payments, a shift UnitedHealth executives have acknowledged they underestimated.

A Series of Federal Probes

The DOJ has zeroed in on UnitedHealth before. An antitrust investigation surfaced in 2024, and in May this year the Wall Street Journal reported that federal investigators had been examining the company’s Medicare Advantage business since at least last summer. “We stand firmly behind the integrity of our Medicare Advantage business,” UnitedHealth said on its website in response to that story.

UnitedHealth shares have tumbled more than 40% this year through Wednesday’s close. After lowering guidance earlier in the spring, the company ultimately withdrew its full-year outlook altogether and reinstalled former CEO and longtime chair Stephen Hemsley to the top job. At the June shareholder meeting, Hemsley announced “a comprehensive review” of practices that have drawn heightened attention, including how the company assigns risk scores that influence Medicare payments.

Source: Bloomberg