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DOJ Expands Probe Into UnitedHealth’s Prescription and Payment Practices

By  |  August 26, 2025
DOJ Expands Probe Into UnitedHealth’s Prescription and Payment Practices

The U.S. Justice Department is intensifying its scrutiny of UnitedHealth Group Inc., widening an ongoing criminal investigation beyond Medicare billing to include the company’s prescription drug management business and physician reimbursement practices, according to Bloomberg. The inquiry is being led by the department’s criminal division, which is examining potential issues with Optum Rx, UnitedHealth’s pharmacy benefit manager, as well as how the company compensates doctors within its vast provider network.

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    Per Bloomberg, the scope of the probe indicates federal investigators are looking more broadly at UnitedHealth’s business practices than previously disclosed. While officials have not accused the company or its executives of wrongdoing, the expanded focus could present greater legal and regulatory challenges. The Justice Department declined to comment on the matter, while UnitedHealth has pointed to a July filing in which it said it is cooperating with investigators and has “full confidence in its practices.”

    The broader investigation comes at a turbulent time for the health care giant. According to Bloomberg, UnitedHealth shares dropped as much as 3.5% following news of the latest scrutiny, compounding losses of roughly 40% this year. The company has struggled with missed earnings, reduced forecasts, and leadership turmoil, including the abrupt resignation of CEO Andrew Witty earlier this year.

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    UnitedHealth is already facing multiple regulatory battles. The Wall Street Journal previously reported that the department’s fraud unit has been reviewing Medicare Advantage billing practices since last summer. Separately, the Justice Department has an ongoing civil antitrust inquiry into the company, while the Federal Trade Commission has sued UnitedHealth and two rival pharmacy benefit managers, alleging they drove up insulin prices. Optum Rx has rejected the FTC’s claims, calling the lawsuit “baseless.”

    Related: UnitedHealth to Divest 164 Facilities Under DOJ Merger Settlement

    Optum Rx, one of the three largest pharmacy benefit managers in the country, generated $133 billion in revenue last year, Bloomberg reported. The company’s operations extend beyond UnitedHealthcare patients to serve external customers through mail-order and specialty pharmacies. Its Optum Health unit, which includes clinics and surgery centers, employs or aligns with about 135,000 physicians and advanced practice clinicians, making UnitedHealth a dominant player in health care delivery as well as insurance.

    Despite ongoing litigation, UnitedHealth has argued that government audits and recent court findings support its compliance record. In March, a court-appointed special master concluded the Justice Department lacked evidence to prove UnitedHealth overbilled Medicare by $2 billion, a central allegation in a separate long-running civil case.

    The mounting legal pressure underscores growing concerns about UnitedHealth’s market power. Regulators are increasingly focused not only on the company’s billing practices but also on whether its integrated model—spanning insurance, pharmacy benefits, and medical care—raises antitrust risks.

    Source: Bloomberg