The federal government has been cracking down on healthcare giant UnitedHealth Group over the past year, and it’s showing no signs of slowing down.
For instance, the Department of Justice began an antitrust probe into the company last February, and then in March, HHS launched an investigation into the catastrophic cyberattack suffered by UnitedHealth subsidiary Change Healthcare. The DOJ also filed a lawsuit to block the UnitedHealth Group’s $3.3 billion acquisition of Amedisys in November.
This week, the company faced two new investigations from federal lawmakers — the first being a senator’s probe into its Medicare Advantage billing practices, and the second being a congressman’s investigation into a decline in care quality at UnitedHealth-owned clinics in New York.
The first new probe came on Monday, when Senator Chuck Grassley (R-Iowa) initiated an inquiry into UnitedHealth Group’s Medicare Advantage billing. He was prompted by reporting from The Wall Street Journal, which suggested the company may have manipulated billing rules for profit. The report stated the DOJ is investigating the company for inappropriately inflating its members’ diagnosis codes to increase reimbursement payments.
UnitedHealth accused The Wall Street Journal of spreading misinformation and denied any fraudulent activity. The company also denied that the DOJ launched an investigation into its Medicare Advantage billing practices.
Grassley has requested detailed records from UnitedHealth CEO Andrew Witty, including compliance documents and training manuals, to assess the company’s billing practices.
The next probe came on Wednesday, when Representative Pat Ryan (D-New York) launched a community inquiry into care quality at clinics owned by UnitedHealth subsidiary Optum. The probe, which targets Optum-owned clinics in New York’s Hudson Valley, comes as a result of constituent complaints about inaccessibility, inaccurate billing, and a reduction in care quality.
“My office has been hearing from folks across the Hudson Valley about a decline in care, especially at CareMount Medical and Crystal Run Healthcare, following their purchase by Optum. I’m launching this community inquiry to hear from as many folks as possible to directly inform my ongoing oversight,” Ryan said in a statement.
The congressman is seeking more feedback from his constituents who receive care or work at Optum facilities in the Hudson Valley.
Optum is looking forward to meeting with policymakers to discuss ways to achieve the “common goal of providing the highest quality patient care,” a company spokesperson wrote in an email to MedCity News.
“Since these practices chose to join Optum, we have introduced a number of new measures to continue to enhance our services, including dedicated teams responsible for scheduling and supporting medication refills and clinical questions, as well as technology investments to improve our patients’ experiences. We, too, have felt the impact of the national healthcare provider shortage and are continuing to invest in solutions to attract, support and retain our dedicated care providers,” the spokesperson wrote.
Photo: MikeyLPT, Getty Images
Note: This article was updated February 28 to include commentary from Optum.