Justice Department Investigates UnitedHealth Group Pharmacy Business and Doctor Reimbursements

A Justice Department criminal investigation of UnitedHealth Group is reportedly broader than initially thought.

Bloomberg reported Tuesday (Aug. 26), citing unnamed sources, that what was once thought to be a probe into possible Medicare fraud is also looking into business practices at the company’s pharmacy benefit manager, Optum Rx, and the ways the company reimburses its own doctors.

The report noted that UnitedHealth and its executives have not been accused of wrongdoing and that the investigation will not necessarily result in charges.

Asked by Bloomberg about the report of a wider probe, UnitedHealth pointed to a July filing with the Securities and Exchange Commission (SEC) in which the company said it has “full confidence in its practices.”

In that filing, UnitedHealth reached out to the Justice Department after reviewing media reports about an investigation into its participation in the Medicare program, is complying with the department’s formal criminal and civil requests, and is committed to working with the department throughout the process.

“The company has a long record of responsible conduct and effective compliance,” the filing said. “Independent CMS [Centers for Medicare & Medicaid Services] audits confirm that the Company’s practices are among the most accurate in the industry, and, following a decade-long civil challenge by the department to aspects of our Medicare Advantage business, a court-appointed Special Master concluded there was no evidence to support claims of wrongdoing.”

According to the Bloomberg report, UnitedHealth Group also faces a Justice Department investigation into potential antitrust issues, a civil fraud investigation into its Medicare billing practices that is separate from the criminal one, and a Federal Trade Commission (FTC) lawsuit alleging an effort to drive up the price of insulin.

Another issue facing UnitedHealth Group is last year’s data breach at its tech unit, Change Healthcare, which was disclosed in February 2024 and was reported to be the largest such occurrence in the U.S. healthcare industry to date.

It was reported Aug. 14 that new data from the Department of Health and Human Services showed that the data breach affected the personal information of 192.7 million people, up from the initial estimate of 190 million provided by UnitedHealth Group in January.