UnitedHealthcare Under Federal Investigation

UnitedHealthcare Under Federal Investigation: Provider Credentialing Chaos and Legislative Pressure 

Olga Khabinskay, Director of Operations, WCH 

 

Major Federal Investigations Shake Healthcare Giant 

UnitedHealth Group is facing unprecedented scrutiny as federal investigations threaten the future of the nation's largest healthcare conglomerate. The Department of Justice has launched both criminal and civil investigations into the company's Medicare billing practices, while Congress has introduced legislation aimed at breaking up UnitedHealth and its subsidiary Optum. 

DOJ Investigates Medicare Billing Practices 

In July 2025, UnitedHealth Group revealed it is facing a Department of Justice investigation over its insurance arm's Medicare billing practices. The company disclosed that it has started complying with formal criminal and civil requests from the DOJ and has launched a third-party review of its business policies and performance metrics. 

The investigation focuses on whether UnitedHealth inflated diagnoses to trigger extra payments to its Medicare Advantage plans. According to reports, DOJ investigators have interviewed several doctors about whether they felt pressured to submit claims for certain conditions that bolstered payments from the Medicare Advantage program to the company. 

The probe comes amid a tumultuous period for the healthcare giant. UnitedHealth Group announced the surprise exit of former CEO Andrew Witty and suspended its 2025 forecast amid skyrocketing medical costs. 

The "Patients Over Profits Act" Targets UnitedHealth-Optum Integration 

In September 2025, Representatives Pat Ryan (D-NY), Val Hoyle (D-OR), and Pramila Jayapal (D-WA), in coordination with Senators Jeff Merkley (D-OR) and Elizabeth Warren (D-MA), introduced the Patients Over Profits Act. This bicameral legislation specifically targets UnitedHealth Group's vertical integration model. 

The proposed legislation would: 

• Bar insurance companies, including UnitedHealth Group, from buying medical practices through subsidiaries like Optum 
• Require existing healthcare conglomerates to separate their insurance and healthcare provider businesses 
• Prevent insurance companies or their subsidiaries from owning a Medicare Part B or C provider 
• Authorize enforcement actions by the FTC, State Attorneys General, HHS Inspector General, or DOJ Assistant Attorney General for Antitrust 

Representative Ryan stated, "UnitedHealth has gobbled up our local healthcare practices, creating a monopoly that directly hurts everyone in our community. In their greedy pursuit of profits, they now own the insurance company, they own your doctor, they own the pharmacy, and they own the software that processes all of your information." 

Optum's Aggressive Acquisition Strategy 

The legislation comes in response to Optum's massive consolidation of healthcare providers. Across the country, Optum has spent $31 billion on acquisitions over a two-year period, purchasing everything from physician practices to ambulatory surgical centers. The subsidiary now employs one in ten physicians nationwide, making it the largest employer of doctors in the United States. 

In Ryan's Hudson Valley district alone, Optum has acquired practices employing more than 2,500 doctors since 2022, including the 2022 purchase of CareMount Medical (2,100 providers) and the 2023 acquisition of Crystal Run Healthcare (400 providers). 

A STAT investigation found that UnitedHealth Group pays its own provider groups more than rival medical clinics, a practice that may undermine competition and drive up prices. The investigation also revealed that UnitedHealth has pressured doctors in medical groups nationwide to diagnose older patients with chronic diseases to help extract higher payments from Medicare. 

Provider Credentialing: Reported Administrative Challenges 

Healthcare providers have reported experiencing difficulties with UnitedHealthcare's credentialing processes, though the extent and systemic nature of these issues remains unclear from publicly available information. Anecdotal reports from providers include concerns about processing delays, communication breakdowns, and inconsistent application of credentialing policies. 

These reported challenges align with broader industry trends identified in credentialing research, including the "2025 State of Payer Enrollment and Credentialing" report from Becker's Hospital Review, which found that many healthcare organizations struggle with high staff turnover in credentialing departments and continued reliance on outdated manual processes that create delays and administrative burdens. 

While individual providers may experience frustrations with credentialing timelines and documentation requirements, comprehensive data on the scope and frequency of these issues, specifically at UnitedHealthcare, is not available in verified public sources. 

Financial Impact and Market Consequences 

The combined pressure from federal investigations, legislative action, and operational challenges has impacted UnitedHealth Group's market position. The company's stock has experienced significant declines during 2025, though exact percentage figures vary by reporting period and source. 

UnitedHealthcare's Medicare and retirement segment, which includes the Medicare Advantage business under investigation, is the company's largest revenue driver, generating $139 billion in sales in 2024. 

Uncertain Future 

UnitedHealth Group faces a Department of Justice antitrust review of Optum's acquisition of medical practices that was opened in February 2024. According to reports, investigators are examining anticompetitive harms for patients and providers. 

As multiple investigations proceed and legislative efforts gain momentum, the future structure of UnitedHealth Group remains uncertain. The Patients Over Profits Act represents the most significant legislative challenge to the vertically integrated healthcare model that UnitedHealth has built over the past decade. 

For healthcare providers navigating the credentialing landscape, the current environment presents challenges that extend beyond any single payer. Industry-wide issues with credentialing processes, combined with the regulatory uncertainty surrounding major healthcare conglomerates, create a complex operational environment that may persist for months or years to come. 

Sources 

1. UnitedHealth Group. (2025, July 24). "UnitedHealth Group responds to Department of Justice investigation." Retrieved from https://www.unitedhealthgroup.com/newsroom/2025/2025-07-24-uhg-responds-to-doj-investigation.html 
2. CNBC. (2025, July 24). "UnitedHealth says it is facing a DOJ investigation over Medicare billing practices." Retrieved from https://www.cnbc.com/2025/07/24/unitedhealthcare-doj-investigation-medicare-billing.html 
3. Congressman Pat Ryan. (2025, September 17). "Congressman Pat Ryan Introduces 'Patients Over Profits Act' To Lower Costs and Improve Care Quality." Retrieved from https://patryan.house.gov/media/press-releases/congressman-pat-ryan-introduces-patients-over-profits-act-lower-costs-and 
4. STAT News. (2025, September 17). "Democrats introduce bill to break up health care conglomerates like UnitedHealth Group." Retrieved from https://www.statnews.com/2025/09/17/unitedhealth-breakup-targeted-new-proposed-law-pat-ryan/ 
5. Healthcare Dive. (2024, February 28). "UnitedHealth under antitrust investigation by DOJ." Retrieved from https://www.healthcaredive.com/news/unitedhealth-antitrust-investigation-doj-unitedhealthcare-optum/708727/ 
6. Senator Jeff Merkley. (2025). "Summary of the Patients Over Profits (POP) Act." Retrieved from https://www.merkley.senate.gov/wp-content/uploads/Patients-Over-Profits-Act-One-Pager.pdf 
7. Becker's Hospital Review. (2025). "The 2025 State of Payer Enrollment and Credentialing." Retrieved from go.beckershospitalreview.com 

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