A new Senate report alleges that UnitedHealth Group aggressively sought diagnoses that could increase its payouts in Medicare Advantage (MA).
The report, first obtained by The Wall Street Journal, sifts through more than 50,000 pages of documents the healthcare giant submitted to the Senate Judiciary Committee last year.
Legislators submitted a request for information in February 2025 after the WSJ and Stat reported that UnitedHealth had a higher coding intensity than its peers in the MA space.
MA plans can earn additional payments from the federal government for patients that have certain high-intensity conditions through the risk adjustment process. The report found that UHG deploys a “robust” workforce around risk adjustment that allows it to capture diagnoses.
The report (PDF) also found that other MA organizations contract with UnitedHealth to capture diagnoses.
“UHG has identified opportunities and strategies to increase its capture of untapped risk score garnering diagnoses and has used its robust provider workforce to implement those strategies,” per the report. “Other MAOs contract with UHG for these coding opportunity insights.”
In addition to the sizable workforce that’s able to conduct health risk assessments in patients’ homes and conduct other outreach, the company also has a robust data and artificial intelligence infrastructure that allows it to capture diagnoses.
The report also notes that when the Centers for Medicare & Medicaid Services (CMS) excluded some 8,000 codes from risk adjustment, UHG was able to deploy the capabilities necessary to identify new opportunities, and their efforts could be replicated by other MA organizations.
“UHG has turned risk adjustment into a major profit centered strategy, which was not the original intent of the program,” the report said.
UnitedHealth has disputed the original reporting that led to the Senate analysis, and, in a statement to the WSJ, said the company is in compliance with CMS regulations.
“We remain focused on continuing to deliver lower costs, better access and higher quality care for the people we serve, including those in Medicare Advantage,” a spokesperson told the WSJ.