By Sneha S K
Jan 12 (Reuters) - Health insurer UnitedHealth Group used aggressive risk-adjustment coding tactics to increase U.S. government reimbursement for patients enrolled in its Medicare Advantage
healthcare plans, a U.S. Senate committee report said on Monday.
Shares of the company were down about 1.6% at $338.21 on Monday morning.
Medicare is a U.S. government program for individuals aged 65 and older or those with disabilities. The government reimburses private health plans, called Medicare Advantage, a set amount for each patient but pays more if patients are sicker.
The report from Senator Chuck Grassley, who chairs the Senate's judiciary committee, said the company submitted more diagnoses and diagnosis codes than any other Medicare Advantage organization. This resulted in higher government payments tied to the poor health of its patients than any of its peers, the report added.
"After a review of the records, this report provides evidence that shows UnitedHealth Group has turned risk adjustment into a major profit centered strategy, which was not the original intent of the program," the report stated.
The investigation was first reported by The Wall Street Journal earlier in the day.
UNITEDHEALTH DISAGREES WITH REPORT'S FINDINGS
A spokesperson for UnitedHealth in an emailed statement said the company disagrees with the committee's characterizations of its Medicare Advantage coding practices and HouseCalls program.
"Our programs comply with applicable (government regulatory) requirements and have, through government audits, demonstrated sustained adherence to regulatory standards," the spokesperson said.
The report was based on over 50,000 pages of UnitedHealth documents including internal training materials, policies and software documentation.
Last year, the WSJ published a series of reports stating that the U.S. Department of Justice was investigating UnitedHealth's Medicare business.
UnitedHealth last year had publicly confirmed it was under investigation by the U.S. Department of Justice and said it was complying with both criminal and civil requests from the federal agency.
(Reporting by Sneha S K in Bengaluru; Editing by Tasim Zahid, Devika Syamnath and Leroy Leo)
