Insurer already faces DOJ Medicare fraud inquiry, Senate panel review
Texas Attorney General Ken Paxton’s office announced Monday that it had sent UnitedHealth Group civil investigative demands to collect evidence of potential Texas Deceptive Trade Practices Act violations, framing the probe as a defense of patients against insurer practices.
The office’s statement highlighted reports alleging that UnitedHealth had bribed nursing homes to delay hospitalizations for patients, directed and in some cases denied patient care over physicians’ judgments, and retroactively withdrew its approval of a prior-authorization request for one Texas patient.
“No Texan should be denied medically necessary care, dragged through endless appeals, or stuck with devastating bills after trusting their insurer’s word,” Paxton said. “My office will gather the evidence, stand up to this multinational conglomerate, and make sure Texans get the coverage they pay for.”
UnitedHealth Group did not immediately respond to a request for comment.
A series of Wall Street Journal articles have reported that UnitedHealth received billions of dollars in federal payments by adding diagnoses to patient records, including some the Journal said were questionable or inaccurate. UnitedHealth has previously disputed the accuracy of that reporting.
Federal scrutiny was already underway. The Journal reported last year, citing people familiar with the matter, that the Justice Department was investigating the company for possible criminal Medicare fraud.
Earlier this year, a Senate committee released a report that said UnitedHealth had used aggressive tactics to collect lucrative diagnoses for Medicare Advantage members.
The investigation’s announcement came as Paxton campaigns for a U.S. Senate seat, where he faces Democratic candidate James Talarico in one of the country’s most closely watched midterm elections.