UnitedHealth Group commits to improvements after independent audit, patient backlash

UnitedHealth Group on Friday released the first results from a sprawling independent audit of its business practices and committed to a wide range of steps to track and implement improvements in three specific areas.

The health-care giant said it has adopted 23 ongoing “action plans” to put in place and monitor recommended improvements, with oversight by its internal audit and advisory services team. Around 65% of those actions will be complete by the end of 2025, while 100% of those plans will be finished by the end of March next year. 

The results come as private insurers try to rebuild trust with the American public after fierce, pent-up backlash over their practices and the broader U.S. health-care system. Critics say insurer business tactics have made it harder for some patients to access and pay for care. The company owns UnitedHealthcare, the nation’s largest and most powerful insurer. 

While the announcement on Friday is a step toward improving the business, it’s unclear how much it will change the public’s view on the company and the broader industry.

UnitedHealth in July announced that two independent consultancies had launched a third-party review of its business policies and performance metrics. That same day, UnitedHealth also confirmed that it is facing Department of Justice investigations over its Medicare billing practices. 

The independent audit marked one of Steve Hemsley’s earliest steps as CEO after he took the reins in May, following the abrupt departure of Andrew Witty.

“We hope that you see these assessments as a commitment to setting a new standard of transparency for the health care marketplace, as we believe that you and every person who engages with our health system deserves to understand how we go about our work,” Hemsley said in a letter on Friday. 

“We know that our actions and decisions have significant impacts on patients, care providers and the broader health system, and we are determined to hold ourselves to the highest standard,” he added.

FTI Consulting reviewed UnitedHealthcare’s approaches to risk assessment operations within its Medicare Advantage programs, which refers to how the company rates the health status of members in those privately run plans. The firm also examined the company’s care services management policies, procedures and processes. 

Consulting firm The Analysis Group also assessed the policies and processes of Optum Rx – the company’s pharmacy benefit manager, or PBM  – for ensuring prescription discounts from drug manufacturers are “accurately collected and distributed to clients.” PBMs are middlemen who negotiate rebates with drug manufacturers on behalf of insurers, create lists of medications covered by insurance and reimburse pharmacies for prescriptions.

Hemsley said the firms determined that the company’s policies and practices are “robust, rigorous and generally sound; and, in many respects, industry leading.” But he noted that they also provided recommendations for improvements. 

For example, a review by the Analysis Group found that OptumRx has “implemented a comprehensive and well-structured framework that governs all stages of manufacturer discount administration.” 

The assessment identified at least 25 distinct “controls” in place that collectively lower the risk of miscalculating or delaying the distribution of discounts owed to clients and collecting incomplete discounts owned from drugmakers, said Aaron Yeater, managing principal at the Boston office of Analysis Group, in a document on Friday. 

The review found “no deficiencies or need for corrective measures” but recommended ways to enhance Optum Rx’s practices. That includes strengthening Optum Rx’s escalation processes for resolving non-payment and dispute cases through communication with manufacturers. Among UnitedHealth’s action plans is to develop a formal policy that supports procedures for addressing those cases. 

Yeater noted that he examined the business processes and not the legal and regulatory issues the company is facing with its PBM.

Meanwhile, FTI Consulting found that UnitedHealth scored better than its peers by several measures when it came to Medicaid and Medicare. But the firm pointed to slow decision-making on authorizations, documentation issues and the need to better address the findings raised in regulatory audits.

Beyond these first results, UnitedHealth said it will share the findings from a review of medical records of diagnosis codes during the first quarter. The company will also report on its processes to craft what it calls “evidence-based medical policy” by the middle of the year. 

Shares of UnitedHealth Group are down more than 35% for the year after it suspended its 2025 forecast amid skyrocketing medical costs, announced the surprise exit of Witty and grappled with the probes into its Medicare Advantage business. It followed a difficult 2014 marked by a historic cyberattack and public blowback after the murder of UnitedHealthcare’s CEO, Brian Thompson.