UnitedHealth Reevaluates ⁤Medicare Advantage Coding amid DOJ ⁢Scrutiny

​ Updated June 03, 2025

UnitedHealth Group is reevaluating how ​it calculates Medicare ​Advantage patients’ diagnoses​ for reimbursement, CEO ⁢Stephen Hemsley told ‌investors. The ‍move ‌comes as the Justice Department investigates the company’s practices regarding Medicare Advantage coding and risk adjustment.

Hemsley’s statement at the⁣ annual shareholder meeting marks a change in tone.UnitedHealth is now publicly acknowledging potential issues with its health assessment methods for Medicare Advantage members. This ⁣represents a shift in UnitedHealth’s approach to Medicare Advantage.

The current stance contrasts sharply with that of Hemsley’s predecessor, Andrew Witty, who earlier this year⁢ pledged to aggressively pursue “engagement,” or risk adjustment coding. Witty had attributed the company’s financial difficulties‍ to government efforts to curb misused codes. Witty stepped down the following ⁣month, citing personal reasons,⁣ and the⁤ company‍ subsequently withdrew its profit forecast for the year, impacting‍ its ⁣ Medicare​ patients.

What’s⁤ next

The reevaluation of coding practices could lead to⁢ meaningful⁣ changes in how UnitedHealth⁢ approaches Medicare Advantage reimbursement and risk adjustment in the future.