Prime Highlights
- UnitedHealth Group has launched a broad reform initiative after releasing the first findings of an independent audit, signaling a stronger push toward transparency and accountability in health-care operations.
- External reviewers found the company’s systems largely strong and industry-aligned, while offering recommendations that UnitedHealth has committed to implementing within a defined timeline.
Key Facts
- The company has adopted 23 action plans, with about 65% set for completion by the end of 2025and all measures expected to be finalized by March next year.
- Independent reviews by FTI Consultingand Analysis Group assessed UnitedHealth’s Medicare Advantage operations and Optum Rx’s prescription discount processes, finding no major deficiencies but identifying areas for operational improvement.
Background
UnitedHealth Group has released the first findings from a wide-ranging independent audit of its business practices, outlining a series of reforms aimed at improving transparency and operational performance across key areas of its health-care operations.
The company said it has adopted 23 ongoing action plans based on recommendations from external reviewers. Around 65 percent of these measures are expected to be completed by the end of 2025, with all initiatives scheduled for completion by March next year. Oversight of the reforms will be handled by UnitedHealth’s internal audit and advisory services team.
The announcement comes as major private insurers face growing public scrutiny over coverage decisions, billing practices, and patient access to care. Critics have long argued that insurer policies contribute to rising health-care costs and delays in treatment, particularly within Medicare and Medicaid programs.
UnitedHealth confirmed that two independent consulting firms, FTI Consulting and Analysis Group, conducted separate reviews focusing on different parts of the company’s operations.
According to UnitedHealth, the reviews found that its policies and systems are generally strong and, in several areas, compare favorably with industry peers. While the review did not find deficiencies requiring corrective action, it recommended strengthening escalation procedures for unresolved disputes with drug manufacturers. UnitedHealth said it will develop formal policies to address such cases.
FTI Consulting’s assessment showed UnitedHealth performed better than competitors on several Medicaid and Medicare measures but highlighted areas where operational efficiency could be improved.
The audit represents one of the earliest major initiatives under CEO Steve Hemsley, who took over leadership in May following the sudden departure of former CEO Andrew Witty. In a letter accompanying the report, Hemsley said the company aims to set a higher standard for transparency and accountability within the health-care industry.
UnitedHealth said additional findings are expected in the coming months, including a review of medical diagnosis coding and an evaluation of how the company develops evidence-based medical policies.
UnitedHealth Group shares have fallen more than 35 percent this year, pressured by rising medical costs, leadership changes, regulatory probes, and lingering fallout from a major cyberattack in 2024.
