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A tracker of healthcare giant UnitedHealth Group’s documented abuses of patients, independent medical practices and pharmacies.

UnitedHealth Group (UHG) is the largest healthcare conglomerate in the country, with over 2,300 different companies. Its business lines include health insurance, pharmacies, pharmacy benefits, surgery centers, primary care clinics, hospice agencies, mental health providers, and home health agencies. Through hundreds of acquisitions in recent years, UnitedHealth Group’s Optum Health subsidiary is now the largest employer of physicians in the country, with 90,000 physicians. Optum is also one of the big three pharmacy benefit managers (PBMs), controlling which drugs an insurance plan will cover. UHG also operates a data and analytics business, Optum Insight, which houses Change Healthcare, as well as its own bank, Optum Bank—the second-largest provider of health savings accounts ($20 billion in assets).

Across these business lines, UnitedHealth Group has a history of denying claims for necessary procedures or medications, unfairly squeezing out independent physician practices and pharmacies, and fraudulently manipulating medical and patient data to maximize its profits.

ABUSE CATEGORIES:

  • Patient Privacy Violation: UHG violates patient privacy by using their data without consent
  • Upcoding and Overbilling: UHG has a history of upcoding–submitting medical codes to federal programs for more serious and more expensive diagnoses or procedures than what was necessary, diagnosed, or performed. As a result, UHG overbills the federal government, wasting millions in taxpayer dollars.
  • Denial of Care: UHG will deny patients the care they need in order to reduce costs and boost company revenue. This includes ignoring medical advice from UHG providers.
  • Anticompetitive Steering of Patients and Providers: UHG’s size, vertical integration, and market power allow the company to utilize anticompetitive tactics to steer patients to UHG owned providers for care, and illegally require practices not to compete for physicians.

According to our calculations, UHG has been accused of engaging in the following activities in the past seven years:

  • Two reports and one lawsuit for violating patient privacy;
  • Seven reports and three lawsuits for upcoding and overbilling the federal government;
  • Seven reports and five lawsuits for denying patient care based on cost instead of medical necessity, and
  • Eight reports and seven lawsuits for steering patients and providers toward UHG owned subsidiaries in order to increase company profits.

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This data was last updated April 11, 2024.

DateCategoryAbuseDetails
3/22/2024Patient Privacy ViolationUHG uses patients’ claims data to target loans to providersUnitedHealth Group is accused of using its proprietary insurance claims data about medical practices to flag prospective borrowers for Optum Bank, potentially in violation of privacy and lending laws. The Department of Justice (DOJ) previously sued UHG for misusing claims data in 2022.
3/18/2024Upcoding and OverbillingUHG whistleblower alleges that Optum Tri-State/Optum East – a subsidiary of UHG – overbills the federal government by overdiagnosing patientsAccording to the whistleblower, Optum executives met to “counsel nurses on how to incorporate additional medical conditions – and thus additional billing codes – from existing data on patient charts.” This would falsely make their patients look sicker than they are so that UHG would be paid more to cover them by the federal government.
3/15/2024Anticompetitive Steering of Patients and ProvidersUHG’s 2023 financials reveal the company skirting federal regulations requiring spending on patient care by shifting money between divisions of the companyThe Medical Loss Ratio (MLR) is a condition under the Affordable Care Act that requires health insurers to spend 80-85 percent of their revenue on medical services. In an effort to fuel earnings and avoid the MLR requirement, UHG has increased “intercompany eliminations” – also known as redirecting money from one part of the company to another – from UnitedHealthcare to Optum to retain profit-capped insurance revenue.
3/14/2024Patient Privacy ViolationFollowing cybersecurity breach, UHG’s Change Healthcare fails to protect personal informationOn February 21, 2024, the information technology network of Change Healthcare – a subsidiary of United Healthcare Group – was breached by a ransomware group, affecting 21 parts of Change’s business. Hospital systems and medical practices could not process patient billing, get reimbursed by insurers, receive payment, or check patients’ insurance eligibility and benefits. Pharmacies were unable to fill prescriptions, while patients were unable to receive necessary medications. One physician noted that their business has gone “5 weeks with $0 in revenue” due to the Change outage.
11/24/2023Anticompetitive Steering of Patients and ProvidersUHG’s Optum allegedly pushed a group of hospitals and physicians to enter an illegal agreement to not compete for primary care physiciansEmanate Health accused Optum of pushing the company to agree not to poach each others’ primary care physicians. When Emanate refused, UHG – with 50% of the Medicare Advantage (MA) and commercial insurance markets – allegedly cut off contracts with Emanate and steered patients to other providers. attempted to force the sale of local practices to Optum. Additionally, UnitedHealth was accused of cutting insurance reimbursement and steering members away from the target practice, and as a condition of insurance contracting, forcing the target practices to give UnitedHealth the first right of refusal upon sale.
11/15/2023
3/13/2023
Denial of CareUHG’s Optum bought and utilized NaviHealth to deny patients’ necessary careUnitedHealth Group purchased NaviHealth, an automated care management system, in May of 2020 for over $1 billion. UHG then used NaviHealth’s prediction algorithm to deny medical care that was necessary to Medicare Advantage seniors, even though the algorithm had an error rate of 90 percent. UHG is facing a class action lawsuit over these allegations. 
11/8/2023Denial of CareUHG’s UnitedHealthcare regularly and illegally refuses to promptly hand over records to patients who had claims deniedAccording to federal law, UnitedHealthcare is required to send claim files back to patients within 30 days, explaining the reasons for any claim denials. However, ProPublica found that UnitedHealthcare - a subsidiary of UHG - failed to follow this timeline.
10/19/2023Denial of CareUHG’s UnitedHealthcare has violated state laws that require insurers to cover certain procedures and medicationsIn Washington state, UnitedHealthcare is facing a $500,000 fine for failing to prove company operations are in compliance with laws for mental and behavioral health coverage requirements.
8/1/2023Denial of CareUHG subsidiary UMR faces Department of Labor lawsuit for denying claims based on diagnostic codes rather than patient needUnitedHealth Group’s subsidiary UMR - a third party administrator of healthcare benefits and services - is being sued by the Department of Labor. UMR is accused of denying thousands of patients’ payments based solely on diagnosis code instead of patient need – which violates the Employee Retirement Income Security Act – and for failing to abide by Affordable Care Act requirements.
6/1/2023Denial of CareUHG’s UnitedHealthcare requires advanced notification requirement for colonoscopy careThe company originally announced a plan to require prior authorization for colonoscopies, at a time when colorectal cancer is on the rise in young people. This sparked providers, medical groups, and patients to condemn the move. As a result, UnitedHealthcare announced “advanced notification requirements” which will similarly deny or delay care.
5/2/2023Anticompetitive Steering of Patients and ProvidersUnitedHealthcare required to pay $91.2 million for underpayment of essential medical careEnvision Healthcare – a physician group – sued UHG’s UnitedHealthcare for underpayment of medical care. Envision and UnitedHealthcare had an in-network agreement, but Envision claimed that the insurer reduced reimbursement to Envision clinicians, violating their agreement.
2/2/2023Denial of CareUHG’s UnitedHealthcare ignores doctors’ advice and denies claims for services they deem not “medically necessary” to reduce spending on care and increase profitsIn one egregious case, UnitedHealthcare flagged a patient as a “high dollar account,” denying care that the company deemed as not “medically necessary.” Court documents revealed that UnitedHealthcare and its’ employees misrepresented critical findings, ignored warnings from doctors about the risk of altering the patients drug plan, inaccurately reported that the patient’s doctor had agreed to lower the doses of his medication, and ignored a doctor’s assessment that denying payments for the patients’ treatment could put his health at risk.
12/21/2022Anticompetitive Steering of Patients and ProvidersUHG’s UnitedHealthcare accused of underpaying out-of-network providersUnitedHealthcare was accused of violating health benefit plans, underpaying out-of-network providers, leaving beneficiaries to pay the bill. This was to reduce the company’s expenses, in violation of the Employee Retirement Income Security Act.
11/21/2022Upcoding and OverbillingCMS finds that UnitedHealthcare has extracted overpayments from the federal governmentBetween 2011 and 2023, CMS conducted over 90 audits on Medicare Advantage overbilling. These audits revealed that UHG’s UnitedHealthcare extracted overpayments at least 8 times in 2007, receiving at least $22.5 million in overpayments.
10/8/2022Upcoding and OverbillingDOJ, Department of Health and Human Services (HHS), and Office of the Inspector General (OIG) of HHS have accused UHG of exploiting Medicare Advantage, including by overcharging the programThe federal government has accused UHG of upcoding - submitting claims for more serious procedures and services than were actually performed or necessary - and fraud.
5/2/2022

Anticompetitive Steering of Patients and Providers

UHG accused of underpaying out-of-network providers to steer providers into UHG-owned Optum practices, which reimburses providers at a higher rateEnvision Healthcare – a physician practice – sued UHG for underpaying out-of-network providers to steer providers into UHG-owned Optum. This leads to higher costs and less access to care for patients.
2/24/2022Upcoding and OverbillingUHG’s OptumRx fails to follow worker’s compensation prescription pricing proceduresUHG’s pharmacy benefit manager OptumRx agreed to pay $5.8 million for allegedly failing to follow workers’ compensation prescription pricing procedures – like a maximum allowable cost – in the state of Massachusetts. These are in place to lower costs and prevent overcharges of the workers compensation system.
8/12/2021Upcoding and Overbilling, Anticompetitive Steering of Patients and Providers, and Denial of CareUHG’s subsidiary United Behavioral Health settles with Department of Labor, NY Attorney General, for underpaying out-of-network providers, overcharging patients, and excessively denying services for patientsUHG’s United Behavioral Health reduced reimbursement rates for out-of-network mental health services, which led to overcharging patients, and excessively denied mental health treatments for New York beneficiaries. This violates the Employee Retirement Income Security Act, and UHG was required to pay nearly $2.1 million in penalties
4/6/2020Anticompetitive Steering of Patients and ProvidersUHG’s United Behavioral Health accused of underpaying out-of-network providersUnitedHealth Group’s subsidiary United Behavioral Health was accused of underpaying out-of-network providers for mental health and substance abuse treatments in California. This would violate the Employee Retirement Income Security Act.
2/23/2020Anticompetitive Steering of Patients and ProvidersUnitedHealthcare drops non-affiliated doctors to force patients to visit UHG-owned providersUHG’s UnitedHealthcare was accused of terminating contracts with non-affiliated physicians in order to force the patients to establish care at nearby Optum practices in New Jersey.
6/1/2017Upcoding and OverbillingCMS requests nearly $800,000 in refunds from UHG overpaymentA Medicare Advantage Risk Adjustment Data Validation audit is the Department of Health and Human Services’ correction action to recoup improper payment - including price gouging - under Medicare Part C. For 2007 audits, CMS requested nearly $800,000 from UHG.
5/16/2017Upcoding and OverbillingDOJ accuses UHG of failing to remove invalid diagnoses after becoming aware of them, and telling workers to mine old medical records for additional illnessesThe DOJ accused UnitedHealth Group of knowingly defrauding the government by obtaining inflated risk adjustment payments based on “inaccurate” and “untruthful” information about beneficiaries, violating the False Claims Act.