The U.S. Department of Justice (DOJ) is carrying out a criminal investigation into UnitedHealth Group for possible Medicare fraud, the Wall Street Journal reported.

New York

UnitedHealth Group is under criminal investigation by the U.S. Department of Justice for possible Medicare fraud, according to a report from the Wall Street Journal citing individuals familiar with the matter. The report indicates that the investigation has been underway since at least the previous year and is being conducted by the healthcare fraud unit within the DOJ’s criminal division. The specific nature of the criminal allegations is not clear based on available information.

This criminal probe comes amid a challenging period for UnitedHealth, a major U.S. health insurer. The company has recently dealt with a cyber attack at its technology unit and the killing of the head of its insurance division, alongside public criticism of the health insurance industry. The report on the investigation followed the sudden departure of UnitedHealth CEO Andrew Witte and the company's suspension of its 2025 financial forecast due to increasing medical costs.

Earlier in the year, the Wall Street Journal reported a separate civil fraud investigation into UnitedHealth's Medicare practices. Around the same time, U.S. Senator Chuck Grassley initiated an inquiry into the company’s Medicare billing processes. UnitedHealth had previously stated it was not aware of any new investigations at that time.

Medicare, the U.S. federal health insurance program for people aged 65 and older or with disabilities, has come under broader scrutiny, especially regarding Medicare Advantage plans operated by private insurers. Nearly half of Medicare’s 65 million beneficiaries are enrolled in these private plans. Separately, the DOJ recently filed a lawsuit against three major U.S. health insurers, accusing them of paying substantial kickbacks to brokers to encourage patient enrollment in Medicare Advantage plans. The payment structure for these plans offers higher reimbursements for patients with multiple health conditions.

Following the news of the new criminal investigation, UnitedHealth’s shares fell to a four-year low. Both UnitedHealth Group and the Department of Justice did not respond to requests for comment from Reuters.



UnitedHealth under criminal probe for possible Medicare fraud

UnitedHealth Group is under a criminal investigation by the U.S. Justice Department for possible Medicare fraud. That's according to a Wall Street Journal report Wednesday which cited people familiar with the matter. While the journal said it's unclear what the exact criminal allegations are, they say the investigation has been active since at least last summer, undertaken by the healthcare fraud unit of the DOJ's criminal division. It would be the latest in a series of setbacks for UnitedHealth, one of the largest health insurers in the U.S. Last year it's seen a cyber attack at its tech unit, the killing of the head of its insurance unit, and subsequent public backlash against the industry. And Wednesday's report comes a day after UnitedHealth Group's CEO Andrew Witte unexpectedly stepped down. The company also suspended its 2025 financial forecast due to rising medical costs. In February, the journal reported a civil fraud investigation into UnitedHealth's practices around Medicare. In the same month, U.S. Senator Chuck Grassley also launched an inquiry into UnitedHealth's practices in Medicare billing. At the time, the company had then said that it was unaware of any new probe. Medicare is the federal health insurance program in the U.S. for people aged 65 and older or with disabilities, and the report of a new investigation follows broader scrutiny into the Medicare Advantage program. Nearly half of the 65 million people covered by Medicare are enrolled in Medicare Advantage plans run by private insurers. The DOJ earlier this month had filed a lawsuit accusing three of the largest U.S. health insurers of paying hundreds of millions of dollars in kickbacks to brokers in exchange for steering patients into the insurer's Medicare Advantage plans. The insurers are paid a set rate for each patient, but can be paid more if patients have multiple health conditions. Wednesday's Wall Street Journal report of a new probe sent UnitedHealth's shares plunging to a four-year low. The company and the DOJ did not immediately respond to Reuters' request for comments.

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