UnitedHealth used HRAs, chart review to boost Medicare Advantage profits

For the nation’s largest health insurer, the evidence of abuse was stunning and unmistakable: UnitedHealth Group reaped billions from the federal Medicare program by diagnosing patients with serious chronic illnesses, and then delivering no follow-up care.

The findings in the federal report reveal that UnitedHealth repeatedly sent clinicians into patients’ homes and pored over their medical charts to add diagnoses for illnesses such as vascular disease, heart failure, and diabetes. The purpose was to collect more cash in Medicare Advantage — not to improve their health. The result? $3.7 billion in dubious payments last year alone.

The revelations contradict a core claim of UnitedHealth’s public messaging about its principal Medicare business strategy — that it’s focused on identifying conditions early and keeping patients healthy — and could usher in further investigations and new restrictions that clamp down on its primary ways of making money.