UnitedHealth (UNH) released the initial findings of a large-scale independent audit of its business practices on Friday, committing to broad measures to track and implement improvements in three specific areas.
The healthcare giant stated it has adopted 23 ongoing "action plans" to execute and monitor recommended enhancements, overseen by its internal audit and advisory services team. Approximately 65% of these actions will be completed by the end of 2025, with all plans finalized by March next year.
The results come as private insurers seek to rebuild public trust amid longstanding criticism of their business practices and the broader U.S. healthcare system. Critics argue insurers' strategies have made it harder for some patients to access and afford care. UnitedHealth owns the nation’s largest and most influential insurer, UnitedHealthcare.
While Friday’s announcement marks a step toward operational improvements, it remains unclear how much this will shift public perception of the company and the industry at large.
UnitedHealth announced in July that two independent consulting firms had initiated third-party reviews of its business policies and performance metrics. The same day, the company confirmed a U.S. Department of Justice investigation into its Medicare billing practices.
The independent audit was among the earliest initiatives under CEO Steve Hensley, who succeeded Andrew Witty after his abrupt departure in May.
"We want you to view these assessments as part of our commitment to setting new transparency standards in healthcare, because we believe you—and everyone interacting with our system—deserve clarity on how we operate," Hensley said in a Friday letter.
"We recognize the significant impact of our actions and decisions on patients, providers, and the broader healthcare system, and we are committed to holding ourselves to the highest standards," he added.
FTI Consulting reviewed UnitedHealthcare’s risk adjustment methodology for its Medicare Advantage plans—how the company assesses members’ health status in these private plans. It also examined UnitedHealth’s care service management policies, procedures, and processes.
Analysis Group evaluated policies and processes at Optum Rx, UnitedHealth’s pharmacy benefit manager (PBM), to ensure prescription drug discounts from manufacturers were "accurately collected and allocated to clients." PBMs negotiate rebates with drugmakers, formulate covered-drug lists, and reimburse pharmacies on insurers’ behalf.
Hensley noted the firms found UnitedHealth’s policies and practices "robust, rigorous, and generally sound—and in many cases, industry-leading," while still recommending improvements.
For example, Analysis Group’s review concluded Optum Rx had "implemented a comprehensive, well-structured framework governing all stages of manufacturer discount management."
Aaron Yetter, managing principal at Analysis Group’s Boston office, stated in a Friday document that the evaluation identified at least 25 existing "controls" collectively reducing risks of miscalculated or delayed client discounts, as well as incomplete manufacturer rebates.
The review found "no deficiencies requiring corrective action" but suggested ways to strengthen Optum Rx’s practices, including enhancing escalation procedures for unresolved payments and disputes through improved manufacturer communication. One action plan involves formalizing policies to support such processes.
Yetter clarified his review focused on business operations, not legal or regulatory issues facing the PBM.
Meanwhile, FTI Consulting found UnitedHealth outperformed peers on multiple Medicaid and Medicare metrics but identified room for improvement in prior authorization decision speed, documentation issues, and addressing regulatory audit findings.
Beyond these initial results, UnitedHealth said it will share findings from a medical-record review of diagnostic coding in Q1 and report midyear on its process for developing "evidence-based medical policies."
UnitedHealth’s shares have fallen over 35% this year after suspending its 2025 forecast amid soaring medical costs, announcing Witty’s unexpected exit, and facing scrutiny over its Medicare Advantage business. The company endured a turbulent 2024, marked by a historic cyberattack and public outcry following the murder of UnitedHealthcare CEO Brian Thompson.
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