UnitedHealth audit says most HouseCalls diagnoses were medically supported
UnitedHealth says an FTI review backed 96.6% of HouseCalls diagnoses, but the real test is whether those codes can withstand Medicare scrutiny.
FTI Consulting examined 200 randomly selected HouseCalls visits from 2025 and 494 Member-HCC diagnoses and found that 96.6% were supported by medical records. UnitedHealth is using the audit to defend HouseCalls, a home-visit program that has become central to its Medicare Advantage business and to the fight over whether in-home assessments can raise risk scores and taxpayer costs.
HouseCalls is part of Optum and sends clinicians into patients’ homes each year to conduct physical exams and review medical history. The visits are offered at no cost to eligible Medicare Advantage and other plan members, and post-visit reports go to treating clinicians with findings, medications, recommendations and vital signs.
Medicare Advantage payments rise and fall with diagnosis codes. The Centers for Medicare & Medicaid Services says its RADV audit program is designed to check whether diagnoses submitted for risk adjustment are supported in enrollees’ medical records, and unsupported diagnoses can lead to recoveries of overpayments. FTI’s finding leaves 3.4% of sampled diagnoses unsupported.
The Department of Health and Human Services has been examining diagnoses that appear only in UnitedHealth’s home-visit assessments and nowhere else in a patient’s chart. A 2025 Senate Judiciary Committee report accused UnitedHealth of turning Medicare Advantage risk adjustment into a profit strategy, and other lawmakers have been scrutinizing whether home-visit and chart-review practices inflate payments.
Wyatt Decker, a UnitedHealth executive, said the company viewed the audit with “both a sense of pride, but also humility,” while arguing that the company wants documentation to reflect diagnoses more accurately. Chief executive Stephen Hemsley argued that the visits can help seniors avoid more expensive medical emergencies later.
UnitedHealth Group’s January 27, 2026 earnings release said 2025 revenue reached $447.6 billion, after a year in which it missed its own profit expectations for the first time since 2008.
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