UnitedHealth Group publishes the results of the independent audit

UnitedHealth Group On Friday, it released the first findings from a sprawling independent audit of its business practices and committed to a broad set of steps to track and implement improvements in three specific areas.

The healthcare giant said it has adopted 23 ongoing “action plans” to develop and monitor recommended improvements, with oversight by its internal audit team and advisory services. About 65% of those procedures will be completed by the end of 2025, while 100% of those plans will be completed by the end of March next year.

These findings come as private insurers try to rebuild trust with the American public after a violent and subdued backlash to their practices and the broader American health care system. Critics say insurers’ business methods have made it difficult 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 the business, it is unclear to what extent it will change the public’s view of the company and the broader industry.

UnitedHealth announced in July that two independent consulting firms had launched a third-party review of its business policies and performance metrics. On the same day, UnitedHealth also confirmed that it was facing a Department of Justice investigation into its Medicare billing practices.

The independent audit represents one of the first steps taken by Steve Hemsley as chief executive after taking over in May, following the shock departure of Andrew Whitty.

“We hope you view these evaluations as a commitment to setting a new standard for transparency in the health care marketplace, because we believe you and everyone who deals with our health system deserves to understand how we do our work,” Hemsley said in a letter on Friday.

He added: “We know that our actions and decisions have significant impacts on patients, carers and the wider health system, and we are determined to adhere to the highest standards.”

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

Consulting firm The Analysis Group also evaluated the policies and processes of Optum Rx — the company’s pharmacy benefit manager, or PBM — to ensure “prescription rebates from drug manufacturers are accurately collected and distributed to customers.” PBMs are intermediaries who negotiate rebates with drug manufacturers on behalf of insurance companies, create lists of drugs covered by insurance and reimburse pharmacies for prescriptions.

The companies determined that the company’s policies and practices were “strong, rigorous, generally sound and, in many respects, industry-leading,” Hemsley said. But he noted they also made recommendations for improvements.

For example, a review by the analysis group found that OptumRx “has implemented a comprehensive, well-organized framework governing all phases of manufacturer rebate management.”

The evaluation identified at least 25 different “controls” in place that collectively reduce the risk of miscalculating or delaying the distribution of rebates owed to customers and collecting incomplete rebates from drug makers, Aaron Yeater, managing director of the analysis group’s Boston office, said in a document released Friday.

The review found “no deficiencies or need for corrective measures” but recommended ways to strengthen Optum Rx practices. This includes enhancing Optum Rx’s escalation processes to resolve non-payment cases and disputes by communicating with manufacturers. One of UnitedHealth’s plans of action is to develop a formal policy that supports procedures for treating these conditions.

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

Meanwhile, FTI Consulting found that UnitedHealth scores better than its peers on several metrics when it comes to Medicaid and Medicare. But the company cited slow decision-making on licenses and documentation issues and the need to better address findings raised in regulatory audits.

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

Shares of UnitedHealth Group fell more than 35% for the year after it suspended its 2025 outlook amid rising medical costs, announced the surprise exit of Witty and fended off investigations into its Medicare Advantage business. It came on the heels of a difficult 2024 marked by a historic cyberattack and public backlash after the killing of UnitedHealthcare CEO Brian Thompson.

Correction: UnitedHealth Group had a tough 2024. An earlier version misstated the year.