UnitedHealthcare and HumanaChoice overbilled Medicare by $180 million

A federal audit by the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) has found that UnitedHealthcare and HumanaChoice overbilled the government through the Medicare Advantage program by a combined $180 million between 2020 and 2021.

The audit alleges the insurers engaged in “upcoding,” a practice where companies exaggerate the health needs of members to receive higher reimbursements. Specifically, the OIG found that diagnosis codes for high-risk conditions—including strokes, embolisms, various cancers, and sepsis—were frequently submitted without sufficient supporting medical documentation.

According to the findings, HumanaChoice owes approximately $131 million in overpayments, while UnitedHealthcare owes roughly $47 million. The OIG has suggested the insurers refund the estimated amounts and strengthen compliance procedures. Both Humana and UnitedHealthcare have contested the audit, stating the methodology was flawed and indicating they do not plan to return the funds.