UnitedHealth Medicare Review: Federal Scrutiny
- UnitedHealth Group is reevaluating how it calculates Medicare Advantage patients’ diagnoses for reimbursement, CEO Stephen Hemsley told investors.
- 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.
- 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.
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.