STAT+: UnitedHealth investor lawsuit moves forward on allegations it ‘manufactured earnings’ to hide declining profits — SkimNews
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- U.S. District Judge Jeffrey Bryan on Wednesday declined UnitedHealth Group's motion to dismiss allegations that the company inflated 2024 earnings by roughly $3.3 billion to hide declining profits in its Medicare Advantage business.
- The California Public Employees' Retirement System (CalPERS), which filed the investor suit, saw most of its broader deception claims thrown out, as the judge agreed with UnitedHealth that many cited statements were too vague or amounted to routine promotional puffery.
- The surviving claim centers on allegations that UnitedHealth concealed an illegal practice of making Medicare Advantage patients appear sicker on paper to draw more money from the government — a scheme CalPERS tied to company statements about home visits and independent clinical decisions.
- Reporting cited in the lawsuit found that UnitedHealth used home visits to add diagnoses to patient records for which members received no follow-up care, and that the company pressured physicians to do the same through bonus incentives.
Why it matters: The ruling keeps alive a $3.3 billion earnings-manipulation claim from a major public pension fund against one of the largest U.S. health insurers, with discovery now likely to probe how UnitedHealth ran its Medicare Advantage risk-adjustment practices — a business line already under federal scrutiny over similar accusations.
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