By Mike Hughlett

Copyright startribune

During a regular office visit, one of Dr. Nancy Keating’s patients mentioned that a UnitedHealth Group representative had recently dropped by her home.

The sixty-something patient belonged to a Medicare Advantage plan run by UnitedHealth. Insurers commonly make such house calls on seniors, but Keating was troubled by the company’s medical review.

UnitedHealth’s assessment included serious medical diagnoses that the patient — referred to as “Mrs. G” in a medical journal article by Keating — didn’t have, like diabetes.

“I was just beyond myself. I’m like, how could they do this?” the Boston physician and Harvard University professor said in an interview about the December 2023 incident. “It was just wrong.”

Adding medical conditions to a Medicare Advantage patient’s records can pull in higher federal payments to insurers while draining money from the taxpayer-supported insurance program. The system is supposed to compensate insurers for covering patients with more complex health conditions.

Yet for more than a decade, alleged diagnostic “upcoding” in Medicare Advantage has led to tens of billions of dollars in suspected overpayments to health insurers at the expense of taxpayers, according to numerous government reports and academic studies.

From the start, Eden Prairie-based UnitedHealth Group and its industry-leading health insurance arm, UnitedHealthcare, has been at the center of the controversy.

In July, UnitedHealth confirmed a U.S. Department of Justice (DOJ) investigation into its Medicare business. The company is cooperating with both the civil and criminal probes, while saying it stands behind the integrity of its programs.