A Senate Judiciary Committee investigation found that UnitedHealth Group Inc. (NYSE:UNH) used aggressive strategies to collect diagnoses that increased federal payments under Medicare Advantage.
In July 2025, the company said it had begun complying with the Department’s formal criminal and civil requests. UnitedHealth says it has full confidence in its practices and is committed to working cooperatively with the Department throughout this process.
The probe began at least a year ago and is now drawing fresh scrutiny as former employees speak with federal investigators.
How Medicare Advantage Payments Work
The Wall Street Journal on Monday reported that Medicare Advantage pays insurers a fixed amount to manage care for seniors and people with disabilities, with higher payments tied to patients diagnosed with costly medical conditions.
According to the Senate report, UnitedHealth transformed that payment adjustment process into a profit driver, a use that investigators said went beyond the program’s original intent.
The findings stem from a review of roughly 50,000 pages of internal documents UnitedHealth provided to the committee last year at the request of Senator Chuck Grassley.
Grassley sought the records after a 2024 investigation by the Wall Street Journal reported that the insurer systematically added diagnoses that generated billions of dollars in additional federal payments.
That Journal investigation reported that some diagnoses were questionable or unsupported, and that patients often did not receive treatment for the added conditions.
The WSJ report added that UnitedHealth has disputed those characterizations, with a company spokesman telling the Journal that the insurer complies with Medicare rules and has performed well in audits of its diagnosis practices.
Details Of UnitedHealth’s Internal Practices
The Senate report stops short of alleging wrongdoing or issuing formal recommendations. However, it provides a detailed account of UnitedHealth’s methods, including deploying nurses for in-home visits, offering financial incentives to physicians to consider additional diagnoses, and using artificial intelligence and data-mining tools to search medical records for new conditions.
Investigators reviewed training materials, internal studies, manuals, and diagnostic guidelines. In some cases, the report said, those guidelines encouraged staff to record diagnoses that triggered higher payments without confirming them through recommended testing.
The insurer has acknowledged that those policy changes contributed to weaker financial results last spring, which led to a sharp drop in its share price.
In December 2025, UnitedHealth disclosed initial findings from a sweeping independent review of its business practices, framing the move as an early step toward greater transparency and operational improvement under new leadership.
Additional Scrutiny And Regulatory Developments
In August 2025, two Democratic senators demanded information from UnitedHealth about the emergency relief loans it provided to healthcare providers after a cyberattack in February 2024 and how it is collecting those debts.
The cyberattack compromised the personal data of 190 million Americans and affected around 900,000 doctors, 33,000 pharmacies, 5,500 hospitals, and 600 labs.
In March 2025, UnitedHealth’s Optum Rx said it would align payment models more closely to the costs pharmacies may face due to manufacturer pricing actions. The company plans a full implementation by January 2028.
UNH Price Action: UnitedHealth Group shares were down 2.51% at $335.35 at the time of publication on Monday, according to Benzinga Pro data.
Photo by Jonathan Weiss via Shutterstock
