Trump’s Focus on Medicare Advantage Fraud Poses Enforcement Test

The Trump administration has vowed to ferret out Medicare Advantage fraud, but keeping that promise will mean overcoming challenges that have stymied Justice Department investigations for years.

Two upcoming cases will give the administration the chance to flex its criminal prosecution muscle: a potential new probe into UnitedHealth Group Inc. as recently reported by the Wall Street Journal, and the just-starting trial of a former HealthSun Health Plans Inc. coding director in Florida.

Upcoding cases—which allege that administrators are fraudulently charging more than what patients need or actually receive—are difficult to prove: they’re time consuming, document-intensive, and complicated, said Barnes ...