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UnitedHealth Group Incorporated is an American multinational managed healthcare and
insurance Insurance is a means of protection from financial loss in which, in exchange for a fee, a party agrees to compensate another party in the event of a certain loss, damage, or injury. It is a form of risk management, primarily used to hedge ...
company based in Minnetonka, Minnesota. It offers health care products and insurance services. UnitedHealth Group is the world's seventh largest company by revenue and the largest healthcare company by revenue, and the largest insurance company by net premiums. UnitedHealthcare revenues comprise 80% of the Group's overall revenue. The company is ranked 11th on the 2022
Fortune Global 500 The ''Fortune'' Global 500, also known as Global 500, is an annual ranking of the top 500 corporations worldwide as measured by revenue. The list is compiled and published annually by ''Fortune'' magazine. Methodology Until 1989, it listed onl ...
. UnitedHealth Group has a
market capitalization Market capitalization, sometimes referred to as market cap, is the total value of a publicly traded company's outstanding common shares owned by stockholders. Market capitalization is equal to the market price per common share multiplied by ...
of $400.7 billion as of March 31, 2021.


History

In 1974, Richard Taylor Burke founded Charter Med Incorporated, a Minnetonka, Minnesota-based privately held company. In 1977, the United HealthCare Corporation was created to reorganize the company and became the parent company of Charter Med. United HealthCare's charter was to manage the newly created Physicians Health Plan of Minnesota, an early health management organization. In 1988, United HealthCare started its first pharmacy benefit management, through its
Diversified Pharmaceutical Services Diversified Pharmaceutical Services entered the market in 1976 as the pharmacy benefit manager for United HealthCare, a leading managed care organization. It pioneered many cost containment strategies that are now core pharmacy benefit manager ...
subsidiary. It managed pharmacy benefits delivered both through retail pharmacies and mail. The subsidiary was sold to SmithKline Beecham in 1994 for $2.3 billion. In 1994, United HealthCare acquired Ramsey-HMO, a Florida insurer. In 1995, the company acquired The MetraHealth Companies Inc. for $1.65 billion. MetraHealth was a privately held company formed by combining the group health care operations of
The Travelers Companies The Travelers Companies, Inc., commonly known as Travelers, is an American insurance company. It is the second-largest writer of U.S. commercial property casualty insurance, and the sixth-largest writer of U.S. personal insurance through indepen ...
and
MetLife MetLife, Inc. is the Holding company, holding corporation for the Metropolitan Life Insurance Company (MLIC), better known as MetLife, and its affiliates. MetLife is among the largest global providers of insurance, Annuity (US financial produc ...
. In 1996, United HealthCare acquired HealthWise of America, which operated HMOs in Arkansas, Maryland, Kentucky and Tennessee. In 1998, the company was reorganized as the holding of independent companies UnitedHealthcare, Ovations, Uniprise, Specialized Care Services and Ingenix, and rebranded as "UnitedHealth Group". Also in 1998, United Health Group acquired HealthPartners of Arizona, operator of Arizona's largest AHCCCS provider. In 2001, EverCare, a UnitedHealth Group subsidiary merged with LifeMark Health Plans In 2002, UnitedHealth Group acquired
GeoAccess GeoAccess, Inc. was a company that pioneered the use of geographic data to analyze the accessibility of health care networks. Prior to GeoAccess’ work in the early 1990s, the accessibility of health care networks was estimated by comparing zip c ...
and Medicaid insurance company AmeriChoice. In 2003, UnitedHealth Group acquired Mid Atlantic Medical Services, an insurer serving Maryland, Washington D.C., Virginia, Delaware and West Virginia. Also in 2003, UnitedHealth Group acquired Golden Rule Financial, a provider of health savings accounts. On July 21, 2003, Exante Bank started operating in Salt Lake City, Utah, as a Utah state-chartered industrial loan corporation. It changed its name to OptumHealth Bank in 2008 and to Optum Bank in 2012. In April 2004, UnitedHealth Group acquired Touchpoint Health Plan, a Wisconsin health plan. In July 2004, the company acquired
Oxford Health Plans Oxford Health Plans is an American health care company that sells various benefit plans, primarily in New York, New Jersey and Connecticut. As of 2004, it is a subsidiary of UnitedHealth Group, the largest healthcare company in the world, cl ...
. In December 2005, the company acquired
PacifiCare Health Systems PacifiCare Health Systems, Inc. was a provider of health insurance based in Cypress, California. It was acquired by UnitedHealth Group in December 2005. History The predecessor of the company was founded in 1978 by Samuel J. Tibbitts as a subsidia ...
. It agreed to divest parts of PacifiCare's commercial health insurance business in
Tucson, Arizona , "(at the) base of the black ill , nicknames = "The Old Pueblo", "Optics Valley", "America's biggest small town" , image_map = , mapsize = 260px , map_caption = Interactive map ...
and
Boulder, Colorado Boulder is a home rule city that is the county seat and most populous municipality of Boulder County, Colorado, United States. The city population was 108,250 at the 2020 United States census, making it the 12th most populous city in Colora ...
to satisfy
antitrust Competition law is the field of law that promotes or seeks to maintain market competition by regulating anti-competitive conduct by companies. Competition law is implemented through public and private enforcement. It is also known as antitrust ...
regulator concerns, and also agreed to end its network access agreement with
Blue Shield of California Blue Shield of California is a mutual benefit corporation and health plan founded in 1939 by the California Medical Association. It is based in Oakland, California, and serves 4.5 million health plan members and more than 65,000 physicians acr ...
. The Tucson business was sold to Cigna. The company acquired Prescription Solutions, another pharmacy benefit manager, as part of its acquisition of
PacifiCare Health Systems PacifiCare Health Systems, Inc. was a provider of health insurance based in Cypress, California. It was acquired by UnitedHealth Group in December 2005. History The predecessor of the company was founded in 1978 by Samuel J. Tibbitts as a subsidia ...
. This business was later rebranded OptumRx. In February 2006, the company acquired
John Deere Deere & Company, doing business as John Deere (), is an American corporation that manufactures agricultural machinery, heavy equipment, forestry machinery, diesel engines, drivetrains (axles, transmissions, gearboxes) used in heavy equipment, ...
Health Care. In February 2008, the company acquired Sierra Health Services for $2.6 billion. As part of the transaction, to obtain regulatory approval, 25,000 customers were sold to Humana. In July 2009, UnitedHealth Group agreed to acquire Health Net's Northeast licensed subsidiaries for up to $570 million in payments spread out over two years. Through 2010 and into 2011, senior executives of the company met monthly with executives of other health insurers to limit the effect of the health care reform law. In July 2010, Ingenix acquired Picis Clinical Solutions, Inc., a health information provider for the high-acuity areas of hospitals. In 2011, Logistics Health, Inc. of
La Crosse, Wisconsin La Crosse is a city in the U.S. state of Wisconsin and the county seat of La Crosse County. Positioned alongside the Mississippi River, La Crosse is the largest city on Wisconsin's western border. La Crosse's population as of the 2020 census wa ...
, was acquired by OptumHealth. In September 2014, the office buildings where LHI is based were sold to UnitedHealth Group for $45 million. In February 2012, the company acquired XLHealth, a sponsor of
Medicare Advantage Medicare Advantage (Medicare Part C, MA) is a capitated program for providing Medicare benefits in the United States. Under Part C, Medicare pays a private-sector health insurer a fixed payment. The insurer then pays for the health care expense ...
health plans with a primary focus on medicare recipients with special needs such as those with chronic illness and those eligible for Medicaid ("dual eligibles"). In October 2012, UnitedHealth Group and Amil Participações, one of the biggest Brazilian health insurance companies, completed the first phase of their merger. In February 2014
Optum
secured a
majority stake A controlling interest is an ownership interest in a corporation with enough voting stock shares to prevail in any stockholders' motion. A majority of voting shares (over 50%) is always a controlling interest. When a party holds less than the major ...
in the Washington, D.C.-based startup Audax Health. Audax's CEO, Grant Verstandig, continued running the firm alongside COO David Ko. In October 2014, Optum Health acquired the health services unit of Alere for $600 million cash. In March 2015, it was announced that CatamaranRx will be acquired by OptumRx. In April 2016, the company announced it was pulling out of all but a "handful" of state healthcare exchanges provided under
Affordable Care Act The Affordable Care Act (ACA), formally known as the Patient Protection and Affordable Care Act and colloquially known as Obamacare, is a landmark U.S. federal statute enacted by the 111th United States Congress and signed into law by Pres ...
and will continue to sell only in three states in 2017. In 2017, UnitedHealth's Optum unit acquired Rally Health, a company started by Audax Health's executives. Prior to acquisition, in 2015, UnitedHealth supported Rally Health as a majority investor, and through enrolling 5 million UnitedHealth policy holders in Rally Health's flagship product, RallySM.Also referred to as Rally. () The close relations between UnitedHealth, Audax Health and Rally Health follows a close personal relationship between Grant Vrestandig (Audax and Rally) and UnitedHealth's
President President most commonly refers to: *President (corporate title) * President (education), a leader of a college or university * President (government title) President may also refer to: Automobiles * Nissan President, a 1966–2010 Japanese ...
and CFO at the time, David Wichmann. In June 2019, UnitedHealth's
Optum Optum, Inc. is an American pharmacy benefit manager and health care provider. It has been a subsidiary of UnitedHealth Group since 2011. UHG formed Optum by merging its existing pharmacy and care delivery services into the single Optum br ...
division acquired Davita Medical Group from DaVita Inc. for $4.3 billion. That year, the company also agreed to acquire Equian for $3.2 billion. On June 19, 2019, UnitedHealth acquired the online patient community platform
PatientsLikeMe PatientsLikeMe is the world’s largest integrated community, health management, and real-world data platform. Through PatientsLikeMe, a growing community of more than 830,000 people with over 2,900 conditions share personal stories and informat ...
for an undisclosed amount and it will be incorporated into UnitedHealth Group's research division. In November 2019,
Andrew Witty Sir Andrew Philip Witty (born 22 August 1964) is a British business executive, who is the current chief executive officer (CEO) of UnitedHealth Group. He was also the CEO of GlaxoSmithKline between 2008 and 2017. He formerly held the role of cha ...
was named president of UnitedHealth, in addition to his role as chief executive of the company's Optum division. UnitedHealth announced in March 2022 that it would acquire LHC Group for $5.4 billion. The deal will expand its home health capabilities by combining LHC's services with UnitedHealth's Optum unit.


Organizational structure


Optum

The Optum brand was created in 2011 as the company's health services business. Optum is UnitedHealth's technology-focused arm. This division also runs the staffed physical care delivery organizations throughout the United States under various brands as a part of the OptumHealth brand.


UnitedHealthcare

UnitedHealthcare includes four divisions: * UnitedHealthcare Employer and Individual - provides health benefit plans and services for large national employers * UnitedHealthcare Medicare and Retirement - provides health and well-being services to individuals age 65 and older. * UnitedHealthcare Community and State - serves state programs that care for the economically disadvantaged, the medically underserved, and people without the benefit of employer-funded health care coverage, in exchange for a monthly premium per member from the state program. * UnitedHealthcare Global - serves 6.2 million people with medical benefits, residing principally in
Brazil Brazil ( pt, Brasil; ), officially the Federative Republic of Brazil (Portuguese: ), is the largest country in both South America and Latin America. At and with over 217 million people, Brazil is the world's fifth-largest country by area ...
,
Chile Chile, officially the Republic of Chile, is a country in the western part of South America. It is the southernmost country in the world, and the closest to Antarctica, occupying a long and narrow strip of land between the Andes to the eas ...
,
Colombia Colombia (, ; ), officially the Republic of Colombia, is a country in South America with insular regions in North America—near Nicaragua's Caribbean coast—as well as in the Pacific Ocean. The Colombian mainland is bordered by the ...
and Peru but also in more than 130 other countries.


Products and services


Health insurance plans

UnitedHealthcare offers commercial
group insurance Group insurance is an insurance that covers a group of people, for example the members of a society or professional association, or the employees of a particular employer for the purpose of taking insurance. Group coverage can help reduce the probl ...
plans across the United States under several product names with different offerings. * UnitedHealthcare Select is an exclusive provider organization (EPO) with no coverage for out-of-network providers * UnitedHealthcare Select Plus is a
preferred provider organization In U.S. health insurance, a preferred provider organization (PPO), sometimes referred to as a participating provider organization or preferred provider option, is a managed care organization of medical doctors, hospitals, and other health c ...
(PPO). * UnitedHealthcare Choice functions as a HMO plan with access to specialists, whereas UnitedHealthcare Choice Plus is an HMO which allows for out-of-network coverage. * UnitedHealthcare Navigate, Charter, and Compass require a
primary care physician A primary care physician (PCP) is a physician who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis. The ter ...
referral to see a specialist meaning that they are more restrictive
managed care The term managed care or managed healthcare is used in the United States to describe a group of activities intended to reduce the cost of providing health care and providing American health insurance while improving the quality of that care ("man ...
plans, similar to point of service plans.


Provider networks

UnitedHealthcare negotiates with providers in periodic contract negotiation; contracts may be discontinued from time to time. High-profile contract disputes can span provider networks across the nation, as in the case of a 2018 dispute with a major emergency room doctor group, Envision Healthcare.


Provider directory

Maintaining up-to-date provider directories is necessary since the
Centers for Medicare and Medicaid Services The Centers for Medicare & Medicaid Services (CMS), is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer M ...
can fine insurers with outdated directories. As a condition of participation, UnitedHealthcare requires that providers notify them of changes, but also has a Professional Verification Outreach program to proactively request information from providers. However, providers are burdened by having to maintain their information with multiple networks (e.g., competitors to UnitedHealthcare). The total cost of maintaining these directories is estimated at $2.1b annually, and a
blockchain A blockchain is a type of distributed ledger technology (DLT) that consists of growing lists of records, called ''blocks'', that are securely linked together using cryptography. Each block contains a cryptographic hash of the previous block, ...
initiative began in 2018 to share the directory.


Finance

For the fiscal year 2020, UnitedHealth Group reported earnings of US$15.40 billion, with an annual revenue of US$257.1 billion.


Criticism and controversies


Lobbying

In 2009, according to
OpenSecrets OpenSecrets is a nonprofit organization based in Washington, D.C., that tracks data on campaign finance and lobbying. It was created from a merger of the Center for Responsive Politics (CRP) and the National Institute on Money in Politics (NIMP) ...
, people affiliated with UnitedHealth Group gave a record of $5.52 million to political candidates and groups. The Affordable Care Act was being discussed in Congress at the time. The Affordable Care Act was subsequently passed in the first quarter of 2010. UnitedHealth Group subsequently spent $2.75 million to $4.86 million from 2011 to 2021 and the company went on to pull in $78,692 million in revenue in the fourth quarter of 2021 alone. The UnitedHealth Group hired seven different lobbying firms to work on its behalf in 2010. In addition, its corporate political action committee or
PAC Pac or PAC may refer to: Military * Rapid Deployment Force (Malaysia), an armed forces unit * Patriot Advanced Capability, of the MIM-104 Patriot missile * Civil Defense Patrols (''Patrullas de Autodefensa Civil''), Guatemalan militia and paramil ...
, called United for Health, spent an additional $1 million on lobbying activities in 2010. QSSI, a subsidiary of UnitedHealth Group, is one of the 55 contractors hired by
United States Department of Health and Human Services The United States Department of Health and Human Services (HHS) is a cabinet-level executive branch department of the U.S. federal government created to protect the health of all Americans and providing essential human services. Its motto is ...
to work on the HealthCare.gov web site.


Legal issues

In 2006, the U.S. Securities and Exchange Commission (SEC) began investigating the conduct of UnitedHealth Group's management and directors, for backdating of stock options. Investigations were also begun by the
Internal Revenue Service The Internal Revenue Service (IRS) is the revenue service for the United States federal government, which is responsible for collecting U.S. federal taxes and administering the Internal Revenue Code, the main body of the federal statutory t ...
and prosecutors in the U.S. attorney's office for the Southern District of New York, who subpoenaed documents from the company. The investigations came to light after a series of probing stories in the ''
Wall Street Journal ''The Wall Street Journal'' is an American business-focused, international daily newspaper based in New York City, with international editions also available in Chinese and Japanese. The ''Journal'', along with its Asian editions, is published ...
'' in May 2006, discussing apparent backdating of hundreds of millions of dollars' worth of stock options by UHC management. The backdating apparently occurred with the knowledge and approval of the directors, according to the ''Journal''. Major shareholders have filed lawsuits accusing former
New Jersey New Jersey is a state in the Mid-Atlantic and Northeastern regions of the United States. It is bordered on the north and east by the state of New York; on the east, southeast, and south by the Atlantic Ocean; on the west by the Delawa ...
governor Thomas Kean and UHC's other directors of failing in their fiduciary duty. On October 15, 2006, CEO
William W. McGuire William McGuire, M.D. (born 1948) is an American healthcare executive best known for his tenure as chairman and chief executive officer of UnitedHealth Group from 1991 until his resignation in 2006, while under investigation for securities fraud, ...
was forced to resign, and relinquish hundreds of millions of dollars in stock options. On December 6, 2007, the SEC announced a settlement under which McGuire will repay $468 million, as a partial settlement of the backdating prosecution. In June 2006, the
American Chiropractic Association The American Chiropractic Association (ACA), based in Arlington, Virginia, represents doctors of chiropractic. Its mission is to inspire and empower its members to elevate the health and wellness of their communities. Purpose and mission The m ...
filed a national class-action lawsuit against the American Chiropractic Network (ACN), which is owned by UnitedHealth Group and administers chiropractic benefits, and against UnitedHealth Group itself, for alleged practices in violation of the federal Racketeer Influenced and Corrupt Organizations Act (RICO).


OptumInsight, aka Ingenix

In February 2008, New York State Attorney General
Andrew Cuomo Andrew Mark Cuomo ( ; ; born December 6, 1957) is an American lawyer and politician who served as the 56th governor of New York from 2011 to 2021. A member of the Democratic Party, he was elected to the same position that his father, Mario Cuo ...
announced an industry-wide investigation into a scheme by health insurers to defraud consumers by manipulating reasonable and customary rates. The announcement included a statement that Cuomo intended "to file suit against Ingenix, Inc., its parent UnitedHealth Group, and three additional subsidiaries." Cuomo asserted that his investigation found that rates found in a database of health care charges maintained by Ingenix were lower than what he determined was the actual cost of certain medical expenses. Cuomo said this inappropriately allowed health insurance companies to deny a portion of provider claims, thereby pushing costs down to members. On January 13, 2009, Ingenix announced an agreement with the New York State attorney settling the probe into the independence of the health pricing database. Under the settlement, UnitedHealth Group and Ingenix would pay $50 million to finance a new, non-profit entity that would develop a new health care pricing database. Ingenix would discontinue its medical pricing databases when the new entity makes its product available. The company acknowledged the appearance of a conflict of interest but admitted no wrongdoing. On January 15, 2009, UnitedHealth Group announced a $350 million settlement of three class action lawsuits filed in Federal court by the
American Medical Association The American Medical Association (AMA) is a professional association and lobbying group of physicians and medical students. Founded in 1847, it is headquartered in Chicago, Illinois. Membership was approximately 240,000 in 2016. The AMA's sta ...
, UnitedHealth Group members, healthcare providers, and state medical societies for not paying out-of-network benefits. This settlement came two days after a similar settlement with Cuomo. On October 27, 2009, Cuomo announced the creation of FAIR Health, the independent, non-profit organization that will develop a nationwide database for consumer reimbursement, as well as a website where consumers will be able to compare prices before they choose doctors. To fund FAIR Health, the Attorney General's office secured nearly $100 million from insurers such as Aetna, UnitedHealth Group, and
Anthem Inc. Elevance Health, Inc. is an American health insurance provider. The company's services include medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans through affiliated companies such as Anthem Blue Cross and ...


Investigations and lawsuits

In 2006, the SEC began investigating the conduct of UnitedHealth Group's management and directors, including Dr. McGuire, as did the
Internal Revenue Service The Internal Revenue Service (IRS) is the revenue service for the United States federal government, which is responsible for collecting U.S. federal taxes and administering the Internal Revenue Code, the main body of the federal statutory t ...
and prosecutors in the U.S. attorney's office for the Southern District of New York, who have subpoenaed documents from the company. The investigations came to light after a series of probing stories in ''
The Wall Street Journal ''The Wall Street Journal'' is an American business-focused, international daily newspaper based in New York City, with international editions also available in Chinese and Japanese. The ''Journal'', along with its Asian editions, is published ...
'' in March 2006, discussing the apparent backdating of hundreds of millions of dollars' worth of stock options—in a process called options backdating—by UnitedHealth Group management. The backdating apparently occurred with the knowledge and approval of the directors, according to the ''Journal''. Major shareholders have filed lawsuits accusing former
New Jersey New Jersey is a state in the Mid-Atlantic and Northeastern regions of the United States. It is bordered on the north and east by the state of New York; on the east, southeast, and south by the Atlantic Ocean; on the west by the Delawa ...
governor Thomas Kean and UnitedHealth Group's other directors of failing in their fiduciary duty.


Resignation of McGuire

On October 15, 2006, it was announced that
William W. McGuire William McGuire, M.D. (born 1948) is an American healthcare executive best known for his tenure as chairman and chief executive officer of UnitedHealth Group from 1991 until his resignation in 2006, while under investigation for securities fraud, ...
would step down immediately as chairman and director of UnitedHealth Group, and step down as CEO on December 1, 2006, due to his involvement in the employee stock options scandal. Simultaneously, it was announced that he would be replaced as CEO by Stephen Hemsley, who has served as president and COO and is a member of the board of directors. McGuire's exit compensation from UnitedHealth, expected to be around $1.1 billion, would be the largest
golden parachute A golden parachute is an agreement between a company and an employee (usually an upper executive) specifying that the employee will receive certain significant benefits if employment is terminated. These may include severance pay, cash bonuses, ...
in the history of corporate America. McGuire's compensation became controversial again on May 21, 2009, when Elizabeth Edwards, speaking on ''
The Daily Show ''The Daily Show'' is an American late-night talk and satirical news television program. It airs each Monday through Thursday on Comedy Central with release shortly after on Paramount+. ''The Daily Show'' draws its comedy and satire form fr ...
'', used it to support her argument for a public alternative to commercial insurance. Edwards stressed the importance of restoring competition in health insurance markets noting that at one point, "the President of UnitedHealth made so much money, that one of every $700 that was spent in this country on health care went to pay him." Since estimates of McGuire's 2005 compensation range from $59,625,444 to $124.8 million, and the revenue of UnitedHealth Group was then $71 billion, it is therefore possible that Mrs. Edwards may have meant that one of every $700 that was spent on UnitedHealth Group premiums went to pay McGuire.


McGuire's settlement with SEC

On December 6, 2007, the SEC announced a settlement under which McGuire was to repay $468 million, including a $7 million civil penalty, as a partial settlement of the backdating prosecution. He was also barred from serving as an officer or director of a public company for ten years. This was the first time in which the little-used "clawback" provision under the Sarbanes-Oxley Act was used against an individual by the SEC. The SEC continued its investigations even after it in 2008 settled legal actions against both UnitedHealth Group itself and its former general counsel.


Medicare overbilling lawsuit

A whistleblower lawsuit, filed in 2011, charges UnitedHealth Group's data analytics division with assisting in defrauding Medicare by boosting risk adjustment scores from
Medicare Advantage Medicare Advantage (Medicare Part C, MA) is a capitated program for providing Medicare benefits in the United States. Under Part C, Medicare pays a private-sector health insurer a fixed payment. The insurer then pays for the health care expense ...
companies. The suit alleges that UnitedHealth Group subsidiary Ingenix (now OptumInsight) "defrauded the United States of hundreds of millions — and likely billions — of dollars." Former UnitedHealth executive Benjamin Poehling brought the suit under the
False Claims Act The False Claims Act (FCA), also called the "Lincoln Law", is an American federal law that imposes liability on persons and companies (typically federal contractors) who defraud governmental programs. It is the federal government's primary litigat ...
. The government said it would proceed on claims against two health care companies, UnitedHealth and its Texas subsidiary WellMed Medical Management. In February 2017, a federal judge unsealed the suit after the Department of Justice announced it would join the case.


''Richard Cole, and others v. United Healthcare''

On April 29, 2019, Judge Robert N. Scola Jr. of the
United States District Court for the Southern District of Florida The United States District Court for the Southern District of Florida (in case citations, S.D. Fla. or S.D. Fl.) is the federal United States district court with territorial jurisdiction over the southern part of the state of Florida.. Appeals ...
, a cancer survivor, recused himself from a case against United Healthcare, stating that the company's denial of treatment was "immoral and barbaric", and that his opinions regarding the company would prevent him from "deciding this case fairly and impartially."


PacifiCare fine in California

In 2008, the
California Department of Insurance The California Department of Insurance (CDI), established in 1868, is the agency charged with overseeing insurance regulations, enforcing statutes mandating consumer protections, educating consumers, and fostering the stability of insurance market ...
took action against UnitedHealthcare's subsidiary
PacifiCare Health Systems PacifiCare Health Systems, Inc. was a provider of health insurance based in Cypress, California. It was acquired by UnitedHealth Group in December 2005. History The predecessor of the company was founded in 1978 by Samuel J. Tibbitts as a subsidia ...
, acquired in 2005, ultimately fining UnitedHealthcare around $173 million for an estimated over 900,000 violations of the Unfair Insurance Practices Act; by 2019, the case was still being disputed in court, with the possibility of affirming $91 million in penalties.


CMS fine over Medicare Part D

In 2017,
CMS CMS may refer to: Computing * Call management system * CMS-2 (programming language), used by the United States Navy * Code Morphing Software, a technology used by Transmeta * Collection management system for a museum collection * Color manage ...
fined UnitedHealthcare after discovering issues in
Medicare Part D Medicare Part D, also called the Medicare prescription drug benefit, is an optional United States federal-government program to help Medicare beneficiaries pay for self-administered prescription drugs. Part D was enacted as part of the Medica ...
leading to delays or denials in a 2016 audit.


New Jersey fine in 2018

The
New Jersey Department of Banking and Insurance New is an adjective referring to something recently made, discovered, or created. New or NEW may refer to: Music * New, singer of K-pop group The Boyz Albums and EPs * ''New'' (album), by Paul McCartney, 2013 * ''New'' (EP), by Regurgitator, ...
fined UnitedHealthcare $2.5 million due to various compliance issues; this was the largest fine against a licensee in nine years.


Pennsylvania

UnitedHealthcare assessed $1 million penalty for claims payment violations.


Northern California

United Behavioral Health sued over $5 million in denied claims.


Policy Research ownership

The Lewin Group is a policy research and consulting firm that provides an economic analysis of health care and human services issues and policies. The organization has existed for about 40 years and has maintained a nonpartisan reputation through its many ownership changes that have occurred over that time. The Lewin Group was purchased in 2007 by Ingenix, a subsidiary of UnitedHealth Group, but alleges editorial and analytical "independence" from UnitedHealth Group, its parent company. The Lewin Group discloses its ownership in its reports and on its website. While the Lewin Group does not advocate for or against any legislation, both Democratic and Republican politicians frequently cite the firm's studies to argue for and against various U.S. healthcare reform proposals. For example, Democratic Senator
Ron Wyden Ronald Lee Wyden (; born May 3, 1949) is an American politician and retired educator serving as the senior United States senator from Oregon, a seat he has held since 1996. A member of the Democratic Party, he served in the United States Hou ...
uses Lewin Group estimates to cite the feasibility of his Healthy Americans Act. Former U.S. Representative Eric Cantor, the former House Republican
Whip A whip is a tool or weapon designed to strike humans or other animals to exert control through pain compliance or fear of pain. They can also be used without inflicting pain, for audiovisual cues, such as in equestrianism. They are generally ...
, has referred to the organization as "the nonpartisan Lewin Group" in arguing against government-funded health insurance proposals. Several Lewin studies have been used to argue both for and against the inclusion of a
public option The public health insurance option, also known as the public insurance option or the public option, is a proposal to create a government-run health insurance agency that would compete with other private health insurance companies within the United ...
in national health reform. Lewin clients who often cite its findings include The Commonwealth Fund which recently held up
Lewin study it commissioned
to advocate for a public plan. The report showed that legislative proposals would achieve nearly universal coverage and "estimated that a public plan could offer small businesses insurance that is at least 9 percent cheaper than current small-business policies." However, The Lewin Group has acknowledged that clients sometimes choose not to publicize the results of studies they have commissioned. Indeed, Lewin Group Vice President John Sheils told ''
The Washington Post ''The Washington Post'' (also known as the ''Post'' and, informally, ''WaPo'') is an American daily newspaper published in Washington, D.C. It is the most widely circulated newspaper within the Washington metropolitan area and has a large n ...
'' that "sometimes studies come out that don't show exactly what the client wants to see. And in those instances, they have heoption to bury the study." Drug and alcohol treatment are generally covered under UnitedHealth Group and UnitedHealthcare plans, but the exact benefits and coverage offered depend on your policy.


Influencing the research of Yale University economist Zack Cooper

In August 2021, a report from ''
The Intercept ''The Intercept'' is an American left-wing news website founded by Glenn Greenwald, Jeremy Scahill, Laura Poitras and funded by billionaire eBay co-founder Pierre Omidyar. Its current editor is Betsy Reed. The publication initially report ...
'' revealed that UnitedHealthcare worked behind the scenes to guide Yale University healthcare economist Zack Cooper's research on surprise medical billing. United provided Cooper with anonymous data and made edits to his paper, which blamed physician networks TeamHealth and Emcare for the rise in balance billing. United Health Network CEO Dan Rosenthal later confirmed United's work with Cooper during a deposition in a lawsuit filed against United by TeamHealth. Cooper's work was presented as independent, unbiased academic research before Congress, the White House, the U.S. Department of Justice, the Federal Trade Commission, and numerous media reports.


Underpaying physicians

In late 2021, Tennessee-based physician network TeamHealth sued UnitedHealthcare in the 8th District Court of Clark County, Nevada, alleging the insurer underpaid claims to three of TeamHealth's Nevada-based affiliates. In November 2021, the jury unanimously found United guilty of "oppression, fraud, and malice" in its conduct and awarded TeamHealth $2.65 million in compensatory damages. In December, the jury reconvened to determine punitive damages and awarded TeamHealth $60 million. TeamHealth plans to pursue similar legal action against United and other insurers in New Jersey, Pennsylvania, New York, Florida, Oklahoma, and Texas.


Change Healthcare

In February 2022, the
United States Department of Justice The United States Department of Justice (DOJ), also known as the Justice Department, is a federal executive department of the United States government tasked with the enforcement of federal law and administration of justice in the United Stat ...
sued to stop UnitedHealth Group's $8 billion acquisition of Change Healthcare, arguing that the deal would give UnitedHealth access to its competitors' data and ultimately push up healthcare cost. The Justice Department said that UnitedHealth knew that access to claims would give it a view into rival health plans at Humana,
Anthem Inc Elevance Health, Inc. is an American health insurance provider. The company's services include medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans through affiliated companies such as Anthem Blue Cross and ...
,
CVS Health CVS Health Corporation (previously CVS Corporation and CVS Caremark Corporation) is an American healthcare company that owns CVS Pharmacy, a retail pharmacy chain; CVS Caremark, a pharmacy benefits manager; and Aetna, a health insurance pro ...
, Aetna, and
Cigna Cigna is an American multinational managed healthcare and insurance company based in Bloomfield, Connecticut. Its insurance subsidiaries are major providers of medical, dental, disability, life and accident insurance and related products and se ...
.


Foundations

UnitedHealth Group has two foundations, the United Health Foundation and UnitedHealthcare Children's Foundation which were formed in 1999. Since established by UnitedHealth Group in 1999 as a not for profit private foundation, the United Health Foundation has committed more than $170 million to improve health and health care.


Notes


References


External links

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UnitedHealth Group Incorporated
recipient profile on USAspending.gov {{DEFAULTSORT:Unitedhealth Group Companies listed on the New York Stock Exchange Companies in the Dow Jones Industrial Average Companies based in Minnetonka, Minnesota Financial services companies established in 1977 American companies established in 1977 Health care companies established in 1977 1977 establishments in Minnesota Health care companies based in Minnesota Health insurance companies of the United States Pharmacy benefit management companies based in the United States 1990 initial public offerings