Bob Herman , 2025-05-16 14:39:00
SAN DIEGO — Optum, the health data and care provider division of UnitedHealth Group, is developing a way to calculate how sick Medicare patients are through artificial intelligence, instead of relying solely on diagnosis codes submitted by physicians.
Ken Cohen, a physician and Optum’s executive director of translational research, said Thursday at a conference organized by America’s Physician Groups that he was working with the Duke-Margolis Institute for Health Policy on this “next generation” of Medicare risk coding using AI.
UnitedHealth and Optum have a significant interest — both reputationally and financially — in helping to build a new type of coding system. The broader company is facing a criminal fraud investigation by the Department of Justice related to Medicare Advantage, the Wall Street Journal reported this week. That comes on top of a civil investigation over its billing and coding, as well as an antitrust investigation.
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