UnitedHealth says audit clears it as Medicare payment probe intensifies

UnitedHealth says audit clears it as Medicare payment probe intensifies UnitedHealth on Tuesday said an audit by an external consulting firm showed nearly 97% of diagnoses identified within its HouseCalls home-health unit were supported by a patient's medical record - Bookmark - CommentsGo to comments UnitedHealth announced Tuesday that an external audit of its HouseCalls home-health unit, which has faced scrutiny from lawmakers, found nearly 97% of identified diagnoses were supported by patient medical records. Wyatt Decker, an executive vice president at UnitedHealth, acknowledged the findings with "both a sense of pride, but also humility," stating the company aims to improve documentation practices by nurse practitioners to more accurately reflect patient diagnoses. The Department of Health and Human Services has been examining diagnoses that appear exclusively in UnitedHealth's home-visit assessments, without corresponding entries elsewhere in a patient's medical history, according to the Wall Street Journal. These patient diagnoses, submitted by HouseCalls, directly influence Medicare Advantage payments to UnitedHealthcare, the company's insurance arm. The report indicated that 3.4% of diagnoses made by HouseCalls clinicians in 2025 lacked supporting documentation. HouseCalls, part of UnitedHealth's Optum primary care business, dispatches clinicians annually to conduct physical exams and review patients' medical histories. UnitedHealthcare manages Medicare Advantage plans for individuals aged 65 and older, as well as those with disabilities, on behalf of the government. In a letter to stakeholders, CEO Stephen Hemsley affirmed the company's commitment to improvement, expressing belief that home visits help seniors avoid more costly medical emergencies. Hemsley had initiated a review of the company’s businesses last year after UnitedHealth missed its profit expectations for the first time since 2008. The analysis was commissioned from business consulting firm FTI Consulting. FTI had previously identified a lack of standardized documentation within UnitedHealth's HouseCalls program. The recent FTI report analyzed 200 visits, encompassing 494 diagnoses. Decker confirmed that this new report has not yet led to changes in the company's policies. Join our commenting forum Join thought-provoking conversations, follow other Independent readers and see their replies Comments