UnitedHealth Group releases results of independent audit
United Health Group On Friday, it announced the preliminary results of a comprehensive independent audit of its business practices and committed to taking a wide range of steps to pursue and implement improvements in three specific areas.
The healthcare giant said it has adopted 23 ongoing “action plans” to implement and monitor recommended improvements under the oversight of its internal audit and consulting services team. Approximately 65 percent of these actions will be completed by the end of 2025, and 100 percent of the plans will be completed by the end of March next year.
The results come as private insurers seek to rebuild trust with the American public following harsh and subdued backlash against their practices and the broader US healthcare system. Critics say the insurer’s tactics make it harder for some patients to access and pay for care. The company owns UnitedHealthcare, the nation’s largest and most powerful insurance company.
While Friday’s announcement is a step toward improving business, it’s unclear how much it will change the public’s view of the company and the industry more broadly.
UnitedHealth announced in July that two independent consultants had initiated a third-party review of its business policies and performance metrics. That same day, UnitedHealth also confirmed it was facing Department of Justice investigations over its Medicare billing practices.
The independent audit was one of Steve Hemsley’s first steps as CEO after taking over in May following the sudden departure of Andrew Witty.
“We hope you view these reviews as a commitment to setting a new standard of transparency in the healthcare marketplace because we believe that you and everyone involved with our healthcare system deserves to understand how we conduct our business,” Hemsley wrote in a letter Friday. he said.
“We know that our actions and decisions have significant impacts on patients, care providers and the broader healthcare system, and we are committed to holding ourselves to the highest standard,” he added.
FTI Consulting reviewed UnitedHealthcare’s approaches to risk assessment operations under Medicare Advantage programs; This refers to how the company rates members’ health in privately run plans. The firm also examined the company’s care services management policies, procedures and processes.
Consulting firm Analysis Group also evaluated the policies and processes of Optum Rx, the company’s pharmacy benefit manager, or PBM, for ensuring drug manufacturers’ prescription rebates are “properly collected and distributed to customers.” PBMs are intermediaries who negotiate discounts with drug manufacturers on behalf of insurance companies, create lists of covered drugs, and reimburse pharmacies for prescriptions.
Hemsley said the firms determined that the company’s policies and practices were “robust, rigorous and generally sound, and industry-leading in many respects.” However, he stated that they also offered suggestions for improvements.
For example, a review by the Analysis Group found that OptumRx “implements a comprehensive and well-structured framework that governs all phases of manufacturer rebate management.”
The assessment identified at least 25 different “controls” that collectively reduce the risk of miscalculating or delaying distribution of rebates owed to customers and collecting missing rebates from drug manufacturers, Aaron Yeater, managing director of Analysis Group’s Boston office, said in a filing Friday.
The review found “no deficiencies or need for corrective measures” but suggested ways to improve Optum Rx’s practices. This includes strengthening Optum Rx’s escalation processes to resolve nonpayment and disputes through communication with manufacturers. UnitedHealth’s action plans include developing a formal policy supporting procedures for these cases.
Yeater stated that the company was examining business processes, not the legal and regulatory issues it faced in its PBM.
Meanwhile, FTI Consulting found that UnitedHealth scores better than its peers on several metrics when it comes to Medicaid and Medicare. However, the firm noted that decision-making was slow regarding authorizations, documentation issues and the need to better address findings in regulatory audits.
Beyond these initial results, UnitedHealth said it will share findings from a review of medical records for diagnosis codes in the first quarter. The company will also report on its processes for creating what it calls “evidence-based medical policy” by mid-year.
Shares of UnitedHealth Group are down more than 35% for the year after it suspended its 2025 forecast due to skyrocketing medical costs, announced the surprise exit of Witty and grappled with investigations into its Medicare Advantage business. This follows a difficult 2014 marked by a historic cyberattack and public outcry following the murder of UnitedHealthcare CEO Brian Thompson.
