Sen. Chuck Grassley (R-Iowa) has sent a letter to UnitedHealth Group CEO Andrew Witty demanding information on the company's Medicare Advantage billing practices.
Grassley wants answers no later than March 10 on the steps UnitedHealth has taken to review all diagnoses submitted to the Centers for Medicare and Medicaid Services for its Medicare Advantage enrollees that were identified only by health risk assessments or chart reviews, either manually or by AI, and to identify all submitted diagnoses that are "obscure, irrelevant or inaccurate."
Grassley is asking for the number and amount of inappropriate payments identified by these actions, and to provide all records. The records relate to the compliance program that UnitedHealth Group had in place from 2019-2024 to monitor the accuracy and appropriateness of the diagnosis codes submitted to CMS for enrollees, including the design and results of all audits conducted, the letter said.
Grassley, chairman of the Senate Judiciary Committee and a former chairman of the Senate Finance Committee, sent the letter on Monday requesting these and other documents.
WHY THIS MATTERS
Grassley's letter follows a report by The Wall Street Journal last week that the Department of Justice has launched an investigation into UnitedHealthcare's medical billing practices that allegedly gave its Medicare Advantage plans additional payments. The new civil fraud investigation is looking at how the company records diagnoses that allegedly trigger the extra payments.
Shares of UnitedHealth went lower upon the news. They fell 7% Friday, according to WSJ, wiping out more than $30 billion in market value.
UnitedHealth has been accused in lawsuits of using AI to deny claims.
THE LARGER TREND
Grassley said he has pressed the Centers for Medicare and Medicaid Services since 2015 to recover improper payments made to Medicare Advantage Organizations, including UnitedHealthcare.
"Despite these oversight efforts, MAOs continue to defraud the American taxpayer, costing them billions of dollars a year," Grassley said.
Email the writer: SMorse@himss.org