UnitedHealthcare and its parent company, UnitedHealth, used “aggressive strategies” to milk American taxpayers by diagnosing Medicare patients with as many conditions as possible, a new Senate report has alleged.
In a 105-page assessment released Monday by the Senate Judiciary Committee, staff members for the Republican majority accused the company of turning federal Medicare subsidies “into a major profit centered strategy”.
By using advanced AI, data-crunching tools, dedicated contractors, and extra screenings, the report alleges, UnitedHealth was able to systematically increase the number of diagnoses it made and therefore the amount of subsidies it received.
At issue is the government’s Medicare Advantage program, which pays out subsidies to private insurers for every Medicare patient they enroll, and offers more money for patients who need more care.
It comes after the Department of Justice opened an investigation into United’s Medicare Advantage practices, following a series of investigations by The Wall Street Journal and the medical news site Stat that revealed evidence of questionable diagnoses.
“Bloated federal spending to UnitedHealth Group is not only hurting the Medicare Advantage program, it’s harming the American taxpayer,” said committee chairman and Iowa Republican senator Chuck Grassley.
“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.”
A UnitedHealth spokesperson said it disagreed with the report’s conclusions and that it complies with Medicare requirements.
More than half of eligible Medicare beneficiaries got their healthcare through Medicare Advantage in 2025, reportedly leading to about $84bn of extra federal spending.
The Centers for Medicare and Medicaid Services (CMS), which manages the program, cracked down on many diagnosis codes last year in an attempt to cut down “excess” payments.
But the Senate report claims that UnitedHealth was able to stay ahead of regulators by using its enormous empire of integrated healthcare businesses, army of dedicated specialists, and high-end data-crunching capabilities to “continuously identify… untapped diagnoses”.
In one example, the report alleges that United advised providers to diagnose all patients taking opioids with “physical dependence,” even if they were taking the painkillers strictly as prescribed.
If those patients then stopped taking opioids, United allegedly taught its providers to diagnose them with “opioid dependence in remission,” potentially for the rest of their lives.
This practice, the report said, has “limited” the government’s ability to use claims data to track the ongoing opioid abuse crisis, since many of the people diagnosed showed “[no] evidence of misuse”.
The Senate’s report made no judgment on whether United’s diagnoses were appropriate. But the Journal’s reporting found “hundreds of thousands of questionable diagnoses,” including ones that were simply untrue.
One patient was reportedly diagnosed with diabetic cataracts, despite not having diabetes, while others were diagnosed with deadly conditions such as AIDS, for which they then received no additional treatment.
The Senate also claims that United advised providers to diagnose patients with an “unspecified alcohol-induced disorder.”
A statement by United last year claimed that the Journal’s reporting was part of a “sustained campaign against Medicare Advantage, relying on incomplete data, a predetermined narrative, and a flawed understanding of how the Medicare Advantage program works.”
It insisted that independent audits had found that it was “among the most accurate in the industry” in diagnosing patients.
The Independent has asked UnitedHealth for comment.
