UnitedHealth found itself under an unforgiving spotlight on Monday, after the release of a U.S. Senate report accusing it of using aggressive risk-adjustment coding tactics to extract billions more in federal reimbursement from Medicare Advantage.
As the market reacted swiftly to send UnitedHealth shares down 1.6 percent in early trading to around $338 per share, the report was dissected in healthcare circles with just as much speed.
Medicare Advantage, designed to care for the sickest and most in need Americans, operates on a simple premise. Private insurers receive a fixed payment per enrollee, with higher reimbursements for patients deemed sicker.
According to the report, authored under the direction of Senate Judiciary Committee chair Chuck Grassley, UnitedHealth leaned into that structure harder than anyone else.
The committee found that UnitedHealth submitted more diagnoses — and more diagnosis codes — than any of its Medicare Advantage competitors, resulting in higher government payments tied to patient severity than its peers. In plain terms, the company appeared exceptionally adept at documenting illness, and exceptionally well rewarded for doing so.
“After a review of the records,” the report stated, “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.”
That framing matters. Because this isn’t just about accounting practices or bureaucratic nuance. It’s about whether a system designed to protect vulnerable Americans has been bent — legally or otherwise — into a revenue engine.
Grassley pulled no punches in a statement. “Medicare Advantage is an important option for America’s seniors, but as the program adds more patients and spends billions in taxpayer dollars, Congress has a responsibility to conduct aggressive oversight,” the senator said.
“Bloated federal spending to UnitedHealth Group is not only hurting the Medicare Advantage program, it’s harming the American taxpayer. My investigation has shown UnitedHealth Group appears to be gaming the system and abusing the risk adjustment process to turn a steep profit. Taxpayers and patients deserve accurate, clear-cut and fair risk adjustment processes.”
The investigation was first reported earlier Monday by The Wall Street Journal, which has been chronicling scrutiny of UnitedHealth’s Medicare operations for more than a year. In 2024, the company confirmed that it was under investigation by the U.S. Department of Justice, cooperating with both civil and criminal inquiries.
UnitedHealth, for its part, pushed back forcefully.
In an emailed statement, a company spokesperson rejected the committee’s conclusions, saying UnitedHealth’s Medicare Advantage coding practices — including its HouseCalls program — comply with all applicable government regulations and have passed multiple audits.
“Our programs comply with applicable requirements and have, through government audits, demonstrated sustained adherence to regulatory standards,” the spokesperson said.
The Senate report drew from more than 50,000 pages of internal company documents, including training materials, policies, and software documentation — a paper trail the committee believes tells a far more intentional story than UnitedHealth acknowledges.
What comes next is unclear. Senate reports do not carry enforcement power, but they shape narratives, sharpen political pressure, and often precede action. For UnitedHealth, already navigating federal investigations, this is another chapter in a story that is no longer just about healthcare delivery — but about trust, scale, and whether the rules of the game were followed in spirit, not just in ink.
Grassley chaired the Senate Finance Committee in 2003, when Medicare Advantage was passed into law. Since then, his website claims, he has acted as both an advocate and a watchdog for the program.
Grassley’s site also included a long list of documents related to the matter, including a letter he had written to UnitedHealth last year “demanding detailed information on the company’s Medicare billing practices,” as well as UnitedHealth’s lengthy response.
He gave examples of opioid prescriptions, alcohol use disorder and dementia as areas of medicine where the coding puzzle can be confusing and the potential for medical groups to exploit the uncertainty may exist.Last October, UnitedHealth announced it would stop offering Medicare Advantage plans in 109 U.S. counties in 2026, citing a combination of funding cuts and higher healthcare costs.