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Carriers & the market

Federal Audit Estimates UnitedHealthcare Benefits of Texas Owes at Least 24.4 Million Dollars in Medicare Advantage Overpayments

Auditors found that medical records did not support most sampled diagnosis codes submitted for 2020 and 2021, adding to a long-running series of federal reviews targeting high-risk coding in Medicare Advantage.

By the Goodsurance editorial teamSeptember 28, 2026

The federal Office of Inspector General posted an audit report on September 28, 2026, finding that UnitedHealthcare Benefits of Texas, Inc., which operates Medicare Advantage contract H0609, likely received at least 24.4 million dollars in overpayments from CMS for plan years 2020 and 2021.

Auditors reviewed 230 sampled enrollee-years and found that 172 of them lacked adequate medical record support for the diagnosis codes UnitedHealthcare submitted to CMS. Those unsupported codes produced 622,927 dollars in documented overpayments within the sample. Extrapolated across the full population of high-risk codes reviewed, OIG estimated at least 24.4 million dollars in total overpayments.

OIG says UnitedHealthcare's Texas Medicare Advantage plan owes at least 24.4 million dollars in unsupported billing.

The audit is part of a continuing OIG series examining whether Medicare Advantage organizations submit diagnosis codes backed by medical documentation. Under the Medicare Advantage risk adjustment program, CMS adjusts monthly payments to plans based on the health status of enrolled members. Diagnosis codes without adequate documentation cause CMS to pay more than the underlying evidence supports.

OIG made four recommendations, the primary one asking CMS to direct UnitedHealthcare Benefits of Texas to refund 24.4 million dollars to the federal government. CMS concurred with all four recommendations. UnitedHealthcare disagreed with some of OIG's findings and asked that all recommendations be withdrawn. OIG maintained its position.

The audit covers January 1, 2020 through December 31, 2021. The report was issued September 23 and publicly posted September 28.

In plain words

A federal watchdog checked how UnitedHealthcare in Texas billed Medicare Advantage. They looked at records for 230 patients over two years. Most of the billing codes did not match what was in the medical records. Because of this, Medicare may have paid too much. The total extra payment could be at least 24.4 million dollars. The government wants that money back. UnitedHealthcare says the finding is wrong.

Understand the basics first

Source: OIG
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