A U.S. Senate committee investigating UnitedHealth Group concluded that the insurer employed systematic methods to inflate Medicare Advantage payments by gathering additional diagnoses for enrolled members. According to a Wall Street Journal–cited report, internal documents reviewed by the committee reveal that UnitedHealth deployed specialized outreach teams and data-mining algorithms to prompt providers for conditions that could raise patients’ risk scores. The inquiry, led by Sen. Chuck Grassley, notes a year-over-year increase in recorded diagnoses per member that outpaces industry peers by approximately 15%, suggesting that the tactics materially boosted government reimbursements. The committee has requested detailed financial records and communications from UnitedHealth dating back to 2020 and warned of potential legislative remedies if the company cannot demonstrate compliance with Medicare rules.

UnitedHealth today released two Milliman–commissioned actuarial studies estimating 2025 costs under Medicare Advantage (MA) versus traditional Medicare. Milliman found that federal spending on MA plans averages $1,117 per member per month—9% below the $1,234 average for traditional Medicare—translating to roughly $1,400 in annual savings per enrollee. These savings have funded $63 billion in enhanced benefits, including dental, vision and hearing coverage, and lower cost sharing. On the beneficiary side, non–dual eligible aged-in MA–Prescription Drug (MA-PD) enrollees are projected to spend $3,651 annually across premiums and out-of-pocket expenses, versus $7,790 under traditional Medicare with a standalone drug plan and Medigap Plan G—a 53% reduction. The studies credit MA’s provider networks, care coordination and value-based payment models as primary drivers of these efficiencies.