UnitedHealth Group releases results of independent audit
UnitedHealthcare’s sign is displayed at its office building in Minnetonka, Minnesota, USA on December 11, 2025.
Tim Evans | Reuters
UnitedHealth Group on Friday released the initial results of a comprehensive independent review of its business practices and committed to a broad range of steps to track 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 supervision of its internal audit and advisory team. About 65% of these measures will be completed by the end of 2025, while 100% of these plans will be completed by the end of March next year.
The findings come at a time when private insurers are trying to restore the trust of the American public after intense, pent-up backlash against their practices and the broader U.S. health care system. Critics say insurers’ business tactics have made it harder for some patients to access and pay for medical care. The company owns UnitedHealthcare, the country’s largest and most powerful insurer.
While Friday’s announcement represents a step toward improving the business, it is unclear to what extent it will change the public’s view of the company and the industry in general.
UnitedHealth announced in July that two independent consulting firms had initiated a third-party review of its business policies and performance metrics. On the same day, UnitedHealth also confirmed that the company was under investigation by the Department of Justice over its Medicare billing practices.
The independent review marked one of Steve Hemsley’s first moves as CEO after he took over in May following the sudden departure of Andrew Witty.
“We hope you see these reviews as a commitment to setting a new standard of transparency for the healthcare marketplace, as we believe you and every person who engages with our healthcare system deserves to understand how we do our work,” Hemsley said in a letter Friday.
“We recognize that our actions and decisions have a significant impact on patients, providers and the entire healthcare system, and we are committed to holding ourselves to the highest standards,” he added.
FTI Consulting reviewed UnitedHealthcare’s approaches to risk assessment within its Medicare Advantage programs. This is about how the company assesses the health of members of these privately managed plans. The company also examined the company’s nursing care management policies, procedures and processes.
Consulting firm Analysis Group also assessed the policies and processes of Optum Rx — the company’s pharmacy benefit manager (PBM) — to ensure prescription discounts from drugmakers are “accurately captured and distributed to customers.” PBMs are middlemen who negotiate discounts with drug manufacturers on behalf of insurers, create lists of drugs covered by insurance, and reimburse pharmacies for prescription costs.
Hemsley said the firms concluded that the company’s policies and practices were “robust, rigorous and generally sound and, in many respects, industry-leading.” However, he noted that they also made suggestions for improvement.
For example, a review by Analysis Group found that OptumRx “implemented a comprehensive and well-structured framework that governs all phases of managing manufacturer rebates.”
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The assessment found that at least 25 different “controls” are in place that collectively reduce the risk of miscalculation or delay in distributing customer rebates and collecting incomplete rebates from drugmakers, Aaron Yeater, managing director in Analysis Group’s Boston office, said in a document Friday.
The review found “no deficiencies or need for corrective action” but recommended ways to improve Optum Rx’s practices. This includes strengthening Optum Rx’s escalation processes to resolve non-payment and dispute cases through communication with manufacturers. UnitedHealth’s action plans include developing a formal policy that supports procedures to address these cases.
Yeater noted that he examined the business processes, not the legal and regulatory issues the company faced with its PBM.
Meanwhile, FTI Consulting found that UnitedHealth performs better than its competitors in Medicaid and Medicare in several ways. However, the company pointed to slow decision-making on permits, documentation issues and the need to better consider lessons learned during regulatory reviews.
Beyond these initial results, UnitedHealth said it will release the results of a medical records review of diagnosis codes in the first quarter. By mid-year, the company will also report on its processes for developing what it calls “evidence-based medical policy.”
Shares of UnitedHealth Group have fallen more than 35% for the year after the company suspended its 2025 forecast amid skyrocketing medical costs, announced the surprise exit of Witty and grappled with investigations into its Medicare Advantage business. A difficult 2024 followed, marked by a historic cyberattack and a public backlash following the assassination of UnitedHealthcare CEO Brian Thompson.
Correction: UnitedHealth Group had a difficult 2024. An earlier version misstated the year.
