00:02Yeah, so as you said, the Wall Street Journal reported last night that the company is under investigation for possible criminal Medicare fraud.
00:11Now, that would be a new development.
00:15We know that there have been investigations on the civil side.
00:19There's a long-running civil case around their Medicare Advantage practices.
00:24This is an area where we've seen increasing enforcement from the government over the past few years around how insurers bill the Medicare system in their Medicare Advantage plans, which has been a big driver of growth for the industry until recently.
00:39So UnitedHealth has said that they have not been notified by the Department of Justice of this supposed criminal investigation and that they stand by the integrity of their Medicare Advantage programs.
00:55Just to be clear, the company essentially denies that it's participated in any kind of fraud.
01:01But what would Medicare fraud look like?
01:04What are these allegations actually about?
01:07Yeah, so the way this business works is that when you sign up for a Medicare Advantage plan from a private insurer, that plan gets a premium from the government to provide your Medicare benefits.
01:19So they get a monthly payment for all of your care.
01:23And that payment is adjusted based on how sick you are.
01:25If you have cancer or diabetes or other conditions, the government pays them more to take care of you because your expected costs will be higher.
01:33Now, that system has been the subject of a huge amount of controversy because of the way that insurance companies and medical clinics can record diagnoses.
01:46Right.
01:47You know, they have the incentive to sort of record all the diagnoses they can.
01:51They get paid more.
01:51And there are cases and allegations involving other companies that they have sort of inflated or exaggerated how sick their patients are to increase their payments.
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