Sen. Grassley presses UnitedHealth Group on billing practices

WASHINGTON – Sen. Chuck Grassley, R-Iowa, chairman of the Senate Judiciary Committee and a former chairman of the Senate Finance Committee, has sent a letter to UnitedHealth Group CEO Andrew Witty demanding detailed information on the company’s Medicare billing practices. 

Grassley’s letter cited reports of apparent fraud, waste and abuse at UnitedHealth Group, including efforts to diagnose enrollees with obscure revenue-generating diagnoses that were irrelevant or inaccurate. This resulted in $8.7 billion in extra payments in 2021 alone, according to reports. 

“Despite these oversight efforts, [Medicare Advantage organizations] continue to defraud the American taxpayer, costing them billions of dollars a year,” he wrote. “The apparent fraud, waste and abuse at issue is simply unacceptable and harms not only Medicare beneficiaries, but also the American taxpayer.” 

In the letter, Grassley requests that UnitedHealth provide answers to the following questions no later than March 10, 2025: 

• What steps has UnitedHealth Group taken to review all diagnoses submitted to CMS for its MA enrollees that were identified only by HRAs or chart reviews (either manual or artificial intelligence) and to identify all submitted diagnoses that are obscure, irrelevant, or inaccurate?  Quantify the number and amount of inappropriate payments identified as a result of these actions. 

• Provide all records that relate to the compliance program that UnitedHealth Group had in place from 2019-2024 to monitor the accuracy and appropriateness of the diagnosis codes submitted to CMS for enrollees, including the design and results of all audits conducted. 

• Provide all training manuals and guidance documents for conducting HRAs and manual chart reviews, a list of all software used during the course of an HRA and a manual chart review, and the logic rules for all electronic decision support tools embedded in the software.  Does UnitedHealth Group use artificial intelligence to conduct the aforementioned processes?  Are all diagnoses identified by artificial intelligence confirmed by a trained medical record reviewer? 

• Provide all policies and procedures for obtaining diagnostic confirmation from an enrollee’s primary care provider and ensuring the receipt of treatment for a new diagnosis identified by an HRA or a chart review.  Provide all documentation related to compliance audits of this process. 

Since 2015, Grassley has pressed CMS and the Department of Justice to recover improper payments made to Medicare Advantage 0rganizations, including UnitedHealth Group.