Recent developments have brought UnitedHealth Group Inc. (NYSE: UNH) under intensified examination by a Senate Judiciary Committee investigation. The probe, which commenced over a year ago, scrutinizes the company’s tactics in aggregating diagnoses that enhance federal Medicare Advantage reimbursements.
In July 2025, UnitedHealth publicly acknowledged initiating full compliance with formal criminal and civil information requests issued by the Department overseeing the case. While the insurer affirms confidence in its methodologies, it has committed to maintaining cooperative engagement with the Department throughout the investigation.
The renewed attention to UnitedHealth's operations has been fueled by accounts from several former employees now providing information to federal investigators. Information obtained by the Senate Committee includes an extensive review of approximately 50,000 pages of documents submitted by UnitedHealth last year at the behest of Senator Chuck Grassley.
The backdrop of this inquiry involves the Medicare Advantage program, wherein insurers receive fixed payments to manage healthcare coverage for seniors and individuals with disabilities. These payments are adjusted based on patient diagnoses, with higher payments allocated when more costly medical conditions are documented. Investigators report that UnitedHealth allegedly exploited this adjustment system, transforming it into a significant revenue driver that, according to findings, may surpass the original program intentions.
According to a Senate report, UnitedHealth's internal strategies included proactive deployment of nurses for in-home patient visits, financial incentives designed to encourage physicians to document additional diagnoses, and the application of artificial intelligence alongside data-mining technologies to comb through medical records for unrecorded conditions.
Documents reviewed include internal training materials, diagnostic guidelines, manuals, and studies outlining the company's practices. Some guidelines reportedly promoted recording diagnoses linked to increased payments without always adhering to recommended confirmatory testing protocols.
The Wall Street Journal previously raised concerns during a 2024 investigation, alleging that UnitedHealth systematically added diagnoses generating billions in extra federal reimbursements, with some conditions being questionable or lacking sufficient patient treatment. UnitedHealth has countered these allegations, emphasizing adherence to Medicare rules and positive outcomes in audits scrutinizing their diagnosis coding.
Highlighting the financial impact, UnitedHealth admitted that changes in policies concerning diagnosis recording contributed to weaker financial performance in the spring of 2025, which corresponded with a notable decline in the company’s share price.
In December 2025, UnitedHealth released preliminary results from a comprehensive independent review of its business operations, describing this initiative as part of a broader effort to enhance transparency and foster operational reforms under recently established leadership.
In addition to Medicare Advantage-related scrutiny, UnitedHealth has faced regulatory questions about other practices. In August 2025, two Democratic senators requested information regarding emergency relief loans the company extended to healthcare providers following a February 2024 cyberattack, which compromised the data of approximately 190 million Americans and impacted numerous healthcare entities including doctors, pharmacies, hospitals, and laboratories. The inquiry also explored how UnitedHealth is managing the recovery of these loaned funds.
Furthermore, in March 2025, UnitedHealth’s pharmacy benefits manager, Optum Rx, announced plans to adjust its payment models to more accurately align with cost fluctuations faced by pharmacies due to manufacturer pricing changes. Full implementation of these adjustments is targeted for January 2028.
According to Benzinga Pro data at the time of publication, UnitedHealth Group shares declined 2.51%, trading at $335.35 on Monday, reflecting the market’s reaction to the unfolding developments.