The Department of Justice has opened a criminal investigation into UnitedHealth Group for possible Medicare fraud, according to recent reports from the Wall Street Journal. The healthcare-fraud unit is overseeing the investigation, which focuses on the company’s Medicare Advantage business practices. This development sent the company’s stock plunging over 15% and led to the unexpected departure of CEO Andrew Witty.
For executives and employees at healthcare companies, this investigation serves as a stark reminder of how quickly a corporate compliance issue can transform into personal criminal exposure.
Understanding Healthcare Fraud Investigations
Healthcare fraud investigations differ from other white collar cases in several important ways. The federal government dedicates substantial resources to investigating Medicare and Medicaid fraud through the DOJ’s Healthcare Fraud Unit, the FBI, the HHS Office of Inspector General, and various U.S. Attorney’s offices across the country.
These investigations typically examine billing practices, upcoding (billing for more expensive services than were provided), kickback arrangements, and false claims submitted to federal healthcare programs. In the UnitedHealth matter, investigators appear to be scrutinizing how the company’s Medicare Advantage business calculated risk adjustments that affect government reimbursements.
Individual Criminal Liability in Corporate Fraud Cases
When the DOJ investigates corporate healthcare fraud, individual employees and executives often face personal criminal exposure. Federal prosecutors have increasingly emphasized holding individuals accountable, not just corporations. As a Board Certified Specialist in Federal Criminal Law, I have seen how employees at all levels can become targets in these investigations.
The key federal statutes that prosecutors typically deploy include:
- 18 U.S.C. § 1347 – Health Care Fraud, carrying penalties up to 10 years imprisonment
- 18 U.S.C. § 1341 – Mail Fraud, with penalties up to 20 years
- 18 U.S.C. § 1343 – Wire Fraud, also carrying up to 20 years
- 18 U.S.C. § 371 – Conspiracy, with penalties up to 5 years
When healthcare fraud affects a federal program or involves more than $100,000 in losses, the potential prison sentences increase substantially under the Federal Sentencing Guidelines.
The Investigation Timeline
Corporate fraud investigations of this magnitude typically unfold over months or years before charges are filed. During this period, the government issues grand jury subpoenas, reviews millions of documents, interviews employees (sometimes with immunity or cooperation agreements), and builds its case methodically.
For individuals who learn they may be subjects or targets of such an investigation, the decisions made in the early stages can dramatically affect outcomes. Whether to cooperate, what to say to investigators, and how to preserve rights while the investigation proceeds are critical strategic decisions.
Protecting Yourself During a Corporate Investigation
If you work for a company under federal investigation, or if you have received a target letter or grand jury subpoena, several steps are essential:
First, understand that the company’s lawyers represent the company, not you. Their interests may diverge from yours. Second, preserve all documents but do not destroy anything—obstruction charges often carry penalties as severe as the underlying offense. Third, consult with an experienced federal criminal defense attorney before speaking with investigators.
Having tried cases in federal courts across North Carolina and represented clients in complex white collar matters, I understand that these investigations create enormous stress and uncertainty. The key is obtaining experienced counsel who can evaluate your specific situation, advise on cooperation strategies where appropriate, and prepare for trial if necessary.
Contact an Experienced Federal Criminal Defense Attorney
If you are facing questions about a healthcare fraud investigation or any federal white collar matter, contact The Chetson Firm for a confidential consultation. With more than 25 jury trials and certification as a specialist in both State and Federal Criminal Law, Damon Chetson provides the aggressive, knowledgeable defense that complex federal cases demand.