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A Wall Street Journal report stated that the probe came on the heels of a spate of exposes that revealed how UnitedHealth allegedly raked billions in dollars in payments for dubious diagnoses. Shares of the company tumbled over 7 percent as news of the probe broke, Reuters reported.
On January 31, per the WSJ report, the attorneys from the Department of Justice interviewed the hospitals and medical providers mentioned in these reports. UnitedHealth has denied the claims, calling them “fake.”
In the case of Medicare Advantage, per the WSJ report, the participating insurers receive fixed payments from the US government to provide Medicare benefits to their enrollees. The payments are adjusted upward depending on the diagnosis of the patients, thus incentivising the insurers to have more conditions documented.
Reportedly, it was alleged that UnitedHealth actively promoted inflation of diagnoses by doctors employed directly by them sometimes to include conditions which were not actually treated.
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