The Senate Judiciary Committee released a 105‑page report on January 12, 2026 that scrutinizes UnitedHealth Group’s Medicare Advantage diagnosis practices. The document, which reviewed roughly 50,000 pages of internal records, alleges that UnitedHealth systematically added diagnoses that increased federal payments by billions of dollars.
The report cites that UnitedHealth’s practices may have generated an estimated $8.7 billion in excess Medicare payments in 2021 alone, and that the Department of Justice’s earlier investigation found more than $7.2 billion in overpayments from 2009 to 2016. These figures illustrate the scale of the alleged up‑coding and the potential financial exposure for the insurer.
UnitedHealth’s strategy, according to the report, has turned the risk‑adjustment component of the Medicare Advantage program—originally designed to compensate for patient health status—into a profit‑centered model. By coding conditions such as “physical dependence” for opioid users or “atrial fibrillation” based on medication rather than diagnostic tests, the company allegedly inflated risk scores and secured higher payments. The findings raise the possibility of civil or criminal penalties and could prompt additional DOJ scrutiny.
UnitedHealth has responded that it disagrees with the report’s conclusions and maintains that it complies with all Medicare requirements. The insurer’s spokesperson emphasized that its internal controls and audit processes are robust, though the company has not yet issued a detailed rebuttal of the specific allegations.
On the day the report was released, UnitedHealth’s shares fell about 1.6 percent, a muted reaction that analysts attribute to the fact that the market had already priced in the regulatory concerns. Bernstein and Evercore ISI continued to issue Outperform ratings, noting that the company’s underlying business fundamentals remain strong despite the scrutiny.
The report underscores the growing regulatory pressure on UnitedHealth and other Medicare Advantage carriers. If the allegations are substantiated, the insurer could face significant financial penalties, increased audit costs, and a need to overhaul its coding practices, all of which could affect future profitability and shareholder value.
The content on BeyondSPX is for informational purposes only and should not be construed as financial or investment advice. We are not financial advisors. Consult with a qualified professional before making any investment decisions. Any actions you take based on information from this site are solely at your own risk.