UnitedHealth Group said it would bolster some compliance and documentation processes in its Medicare billing and other areas as a result of a review that it commissioned.
The review, by outside consultants, was announced in June by Chief Executive Steven Hemsley soon after he returned to the CEO job, and it was one of three focused on topics where the company has drawn scrutiny. The other two reviews focused on drug rebates and insurance processes used to manage care, such as pre-authorization.
UnitedHealth's Medicare billing has come under Justice Department investigation. A company spokesman declined to comment on the Justice Department.
In a letter, Hemsley said the company planned to release further reviews next year, including one focused on its program that sends nurses to Medicare enrollees' houses, which was the focus of a report last year by the Department of Health and Human Services' inspector general. Hemsley said work on the initial reviews' recommendations "is already well under way" and the rest will be completed before the end of the first quarter of 2026.
The three initial company-commissioned reviews, which mostly focused on internal processes and compliance policies, generally praised UnitedHealth's practices and recommended limited reforms.
The Medicare billing review focused on risk adjustment, which is the process of documenting patients' diagnoses, some of which can increase Medicare payments to insurers. The Wall Street Journal investigated Medicare billing at UnitedHealth and other insurers last year. The company said it would establish an independent audit team within its Optum health-services arm to examine medical coding.
In the area of care management, UnitedHealth said it would bolster its processes to ensure that improvements drawn from audits are consistently implemented.
On drug discounts, the company said it would examine some audits from its clients to "implement process and control improvements."
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