ai medical coding,ai claims auditor,pcg,pcg software,vews,virtual examiner,ivecoder,virtualauthtech
Andria Jacobs
December 13, 2023

UnitedHealthcare Fraud, Violations, and Settlements


This is a Live Blog about UnitedHealthcare Fraud and Violations


As a provider, Health Plan, MSO, IPA, every day we’re trying our best to help patients and providers without increasing the cost of healthcare. However, the biggest National Health Insurer continues to raise the cost of healthcare and violate the same rules and regulations that you and we aim to avoid.  We aim to begin documenting and updating every possible fraud, waste, abuse, and violation, so you the reader have one article to bookmark and keep up to date on.


Latest 2025 Updates

  • February 21, 2025: Medicare Diagnosis Fraud. US Justice Department is opening a Civil Fraud Investigation in regards to illegally using patient diagnoses to increase lump sum monthly payments received through Medicare (source1, source2).
  • February 24, 2025: Telemarketing Violation Settlement. $2.5 million settlement was reached for New Yorkers who could receive up to $1,000 per person for violating hte Federal Telephone Consumer Protection Act (source).


UnitedHealth Group Violations Summary

If you’ve never visited Taken from Good Jobs First, you’re missing out on one of the biggest fraud and violation trackers in the world! Let’s take a look at UnitedHealth Group’s violations and get a full picture of the fraud, waste, and abuse that continues in their organization. We thank them for bringing information into the mainstream media like the data seen below:


UnitedHealth Group’s Top 5 Findings of Fraud

Top 5 Offenses by "Group" Penalty Total Number of Records Avg. for Each Group
consumer-protection-related offenses $827,406,143 333 $2,484,703
government-contracting-related offenses $196,539,180 8 $24,567,398
competition-related offenses $63,125,000 3 $21,041,667
employment-related offenses $44,958,410 22 $2,043,564
healthcare-related offenses $4,898,000 4 $1,224,500
$1,132,028,733 366 $3,092,975
Top 5 Primary Offense "Types" PENALTY TOTAL NUMBER OF RECORDS Avg. for Each Group
consumer protection violation $433,176,667 18 $24,065,370
insurance violation $393,524,476 312 $1,261,296
False Claims Act and related $196,539,180 8 $24,567,398
price-fixing or anti-competitive practices $63,125,000 3 $21,041,667
benefit plan administrator violation $35,534,249 3 $11,844,750
$1,086,365,323 341 $3,185,822
Company Offense Type Year Agency Penalty Amount
UnitedHealth Group, Inc. consumer protection violation 2010 private lawsuit-federal $350,000,000
Pacificare Life and Health Insurance Co. insurance violation 2014 CA-INS $173,603,750
PacifiCare Health Systems False Claims Act and related 2002 DOJ_CIVIL $87,300,000
LHC Group Inc. False Claims Act and related 2011 DOJ_CIVIL $65,000,000
UnitedHealth Group Inc. consumer protection violation 2009 NY-AG $50,000,000

Additional UnitedHealth Group Fraud and Articles for Reference



Justice.gov Article on UnitedHealth Group Fraud 2017

DOJ Sues UnitedHealth for $1 Billion

2010 $350,000 Million in Fraud

2014 $173,603,750 in Fraud

New York Times: UHG whistleblower, US Government Fraud, OIG

DOJ drops UHG lawsuits and crumbles under pressure

Louisiana AG sues UHG over Medicaid Fraud

UHG Hides Compliants over MA Plans

UHG wins Fraud suing Labs Company… Why didn’t they review their claims first?



The list goes on and one, all you have to do is search “UnitedHealth Group Fraud” and the results are overwhelming. We hope this short article has opened your eyes to fraudulent abuses that UHG has continued to get away with and will continue to perform in the future. 

Our History and Credibility in Reporting this Information:


For over 30 years, PCG Software Inc. has been a leader in AI-powered medical coding solutions, helping Health Plans, MSOs, IPAs, TPAs, and Health Systems save millions annually by reducing costs, fraud, waste, abuse, and improving claims and compliance department efficiencies. Our innovative software solutions include Virtual Examiner® for Payers, VEWS™ for Payers and Billing Software integrations, and iVECoder® for clinics.

DOGE and CMS,DOGE audits CMS
By Will Schmidt February 11, 2025
Real-time article chronically DOGE's auditing of CMS and US Healthcare costs to help reduce the cost of healthcare and save taxpayer spending.
Healthcare Mergers,Healthcare Acquisitions,healthcare m&a,what to expect in a healthcare acquisition
By Will Schmidt January 28, 2025
How to navigate the healthcare merger and acquisition market in 2025. Strategies, tips, real-life scenarios, and guidance from PCG's CSO who's been through them, on both sides of the table, and lived to tell about it.
More Posts
Share by: