SEC investigation In 2006, the
U.S. Securities and Exchange Commission (SEC) began investigating the conduct of UnitedHealth Group's management and directors, for
backdating of stock options. Investigations were also started by the
Internal Revenue Service and prosecutors in the U.S. attorney's office for the Southern District of New York, who subpoenaed documents from the company. The investigations came to light after a series of probing stories in the
Wall Street Journal in May 2006, discussing the apparent backdating of hundreds of millions of dollars' worth of
stock options by UHC management. The backdating apparently occurred with the knowledge and approval of the directors, according to the
Journal. Major shareholders have filed lawsuits accusing former
New Jersey governor
Thomas Kean and UHC's other directors of failing in their fiduciary duty. On October 15, 2006, CEO
William W. McGuire was forced to resign, and relinquish hundreds of millions of dollars in stock options. On December 6, 2007, the SEC announced a settlement under which McGuire was to repay $468million, including a $7million civil penalty, as a partial settlement of the backdating prosecution. He was also barred from serving as an officer or director of a public company for ten years. This was the first time in which the little-used "
clawback" provision under the
Sarbanes-Oxley Act was used against an individual by the SEC. The SEC continued its investigations even after it in 2008 settled legal actions against both UnitedHealth Group itself and its former general counsel.
American Chiropractic Association lawsuit In June 2006, the
American Chiropractic Association filed a national class-action lawsuit against the American Chiropractic Network (ACN), which is owned by UnitedHealth Group and administers
chiropractic benefits, and against UnitedHealth Group itself, for alleged practices in violation of the federal
Racketeer Influenced and Corrupt Organizations Act (RICO). The Missouri Department of Insurance, Financial Institutions and Professional Registration determined that UnitedHealth Group violated state insurance laws, so levied $536,000 in fines and ordered more than 50,000 cases re-opened; any improperly denied claims must have been reimbursed with interest for chiropractors and patients.
OptumInsight, Ingenix lawsuit In February 2008, New York State Attorney General
Andrew Cuomo announced an industry-wide investigation into a scheme by health insurers to defraud consumers by manipulating reasonable and customary rates. The announcement included a statement that Cuomo intended "to file suit against Ingenix, Inc., its parent UnitedHealth Group, and three additional subsidiaries." Cuomo asserted that his investigation found that rates found in a database of health care charges maintained by Ingenix were lower than what he determined was the actual cost of certain medical expenses. Cuomo said this inappropriately allowed health insurance companies to deny a portion of provider claims, thereby pushing costs down to members. On January 13, 2009, Ingenix announced an agreement with the New York State attorney settling the probe into the independence of the health pricing database. Under the settlement, UnitedHealth Group and Ingenix would pay $50million to finance a new, non-profit entity that would develop a new healthcare pricing database. Ingenix would discontinue its medical pricing databases when the new entity makes its product available. The company acknowledged the appearance of a conflict of interest but admitted no wrongdoing. On January 15, 2009, UnitedHealth Group announced a $350million settlement of three class action lawsuits filed in Federal court by the
American Medical Association, UnitedHealth Group members, healthcare providers, and state medical societies for not paying out-of-network benefits. This settlement came two days after a similar settlement with Cuomo. On October 27, 2009, Cuomo announced the creation of
FAIR Health, an independent, non-profit organization that would develop a nationwide database for consumer reimbursement, as well as a website where consumers would be able to compare prices before choosing doctors. To fund FAIR Health, the Attorney General's office secured nearly $100million from insurers such as
Aetna, UnitedHealth Group, and
Anthem Inc. PacifiCare fine in California In 2008, the
California Department of Insurance took action against UnitedHealthcare's subsidiary
PacifiCare Health Systems, acquired in 2005, ultimately fining UnitedHealthcare around $173million for an estimated over 900,000 violations of the Unfair Insurance Practices Act; by 2019, the case was still being disputed in court, with the possibility of affirming $91million in penalties.
Medicare overbilling lawsuit A
whistleblower lawsuit filed in 2011 charged UnitedHealth Group's data analytics division with assisting in defrauding
Medicare by boosting risk adjustment scores from
Medicare Advantage companies. The suit alleged that UnitedHealth Group subsidiary Ingenix (now OptumInsight) "defrauded the United States of hundreds of millions – and likely billions – of dollars." Former UnitedHealth executive Benjamin Poehling brought the suit under the
False Claims Act. The government said it would proceed on claims against two healthcare companies, UnitedHealth and its Texas subsidiary WellMed Medical Management. In February 2017, a federal judge unsealed the suit after the
Department of Justice announced it would join the case.
CMS fine over Medicare Part D In 2017, the
Centers for Medicare and Medicaid Services (CMS) fined UnitedHealthcare $2.5million after discovering issues in
Medicare Part D leading to delays or denials in a 2016 audit.
2018 New Jersey fine In 2018, the
New Jersey Department of Banking and Insurance fined UnitedHealthcare $2.5million due to various compliance issues; this was the largest fine against a licensee in nine years.
Richard Cole, and others v. UnitedHealthcare On April 29, 2019, Judge
Robert N. Scola Jr. of the
United States District Court for the Southern District of Florida, a
cancer survivor,
recused himself from a case against UnitedHealthcare, stating that the company's denial of treatment was "immoral and barbaric", and that his opinions regarding the company would prevent him from "deciding this case fairly and impartially."
Mental health treatment lawsuit As reported by openminds.com:
Pennsylvania lawsuit In 2019, UnitedHealthcare paid a $1million penalty to settle Pennsylvania regulators' allegations that the company violated state and federal laws when paying medical claims, particularly for patients seeking treatment for autism and substance use disorders. The regulators also compelled the company to pay restitution for wrongly denied or delayed claims and to spend $800,000 on an outreach campaign to notify consumers of their mental health and substance use disorder benefits.
Dispute with TeamHealth In late 2021, Tennessee-based physician network
TeamHealth, a subsidiary of the private equity company
Blackstone Inc., sued UnitedHealthcare in the 8th District Court of
Clark County, Nevada, alleging the insurer underpaid claims to three of TeamHealth's Nevada-based affiliates. In November 2021, the jury unanimously found United guilty of "oppression, fraud, and malice" in its conduct and awarded TeamHealth $2.65million in compensatory damages. In December, the jury reconvened to determine punitive damages and awarded TeamHealth $60million. TeamHealth plans to pursue similar legal action against United and other insurers in
New Jersey,
Pennsylvania,
New York,
Florida,
Oklahoma, and
Texas.
Medicare Advantage overbilling An October 2021
New York Times report identified UnitedHealth in a list of
Medicare insurers accused of over-billing. According to the Inspector General, a
whistleblower came forward, so the U.S. government went after UnitedHealth for over-billing Medicare. Executives at UnitedHealth Group told workers to mine old medical records for more illnesses, to identify diagnoses of serious diseases that might have never existed, inflating bills paid by the federal government's Medicare Advantage program. A study by the Kaiser Family Foundation found that in 2021,
Medicare Advantage programs provided insurers with double the
gross margin of insurance for individuals, groups, or Medicaid Managed Care. In July 2024, the
Wall Street Journal concluded that UnitedHealth was the worst offender among private insurers who made dubious diagnoses in their clients in order to trigger large payments from the government's
Medicare Advantage program. The patients often did not receive any treatment for those insurer-added diagnoses. The report, based on Medicare data obtained from the federal government under a research agreement, calculated that diagnoses added by UnitedHealth for diseases patients had never been treated for had yielded $8.7billion in payments to the company in 2021 – over half of its net income of $17billion for that year. In July 2025, the Wall Street Journal reported that DOJ officials were interviewing former UnitedHealth employees in connection with the investigation, and later that month, UnitedHealth confirmed that it was under criminal and civil federal investigation for its Medicare practices.
Change Healthcare acquisition In February 2022, the
United States Department of Justice sued to stop UnitedHealth Group's $8 billion acquisition of
Change Healthcare, arguing that the deal would give UnitedHealth access to its competitors' data and ultimately push up healthcare costs. The Justice Department said that UnitedHealth knew that access to claims would give it a view into rival health plans at
Humana,
Anthem Inc,
CVS Health,
Aetna, and
Cigna. A U.S. judge rejected the department's bid in September. Following the completion of the acquisition in October 2022, the parties agreed that the appeal would be voluntarily dismissed, with no reasons provided by the Justice Department for dropping the appeal.
Secret payments to nursing homes In May 2025,
The Guardian published an investigative report which uncovered a systemic effort by UnitedHealth to secretly pay nursing homes bonuses to deny hospital transfers for nursing home residents who needed
immediate hospital care. Other tactics uncovered by
The Guardian include UnitedHealth managers pressuring nurse practitioners to persuade members to sign onto
Do not resuscitate agreements and payments for
leaking confidential patient data to UnitedHealth sales teams. In June, UnitedHealth sued
The Guardian for defamation over the findings of their article.
2025 Investigations into Medicare billing practices In July 2025, UnitedHealth Group was under both civil and criminal investigations by the U.S. Department of Justice into how it bills its Medicare Advantage program and related practices, and said it cooperated with those probes after reaching out to the DOJ. ==Foundations==