WSJ says Department of Justice investigating Medicare Advantage coding at

The Wall Street Journal says the Justice Department in recent months has launched a new investigation into UnitedHealth Group’s billing practices as a civil fraud investigation looks at the use of diagnosis data to trigger extra payments to the company’s Medicare Advantage plans.

Shares of the Eden Prairie-based company’s stock were down roughly 9% in morning trading Friday.

“We are not aware of the ‘launch’ of any ‘new’ activity as reported by the Journal,” UnitedHealth Group said in a statement Friday.

“We are aware, however, that the Journal has engaged in a year-long campaign to defend a legacy [Medicare] system that rewards volume over keeping patients healthy and addressing their underlying conditions,” the company said. “Any suggestion that our practices are fraudulent is outrageous and false.”

Medicare Advantage is a privatized version of the federal health insurance program for seniors, where the government hires health plans to manage care for patients and pays companies more when seniors need more treatment — creating a financial incentive for insurers to document as many diagnoses as possible.

The Journal reported Medicare Advantage insurers overall diagnosed patients with conditions that triggered extra payments of $50 billion from 2019 to 2021, even though no doctor ever treated the diseases.

These health plans sent their own nurses to visit patients at home and diagnose them with conditions that their doctors hadn’t, the news outlet said, triggering an average of $1,818 in extra annual payments during each visit during the time period.