A tracker of healthcare giant UnitedHealth Group’s documented abuses of patients and 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. Optum Insight accounts for thirty percent of UHG’s total revenue in 2023. UnitedHealth Group also operates its own bank, Optum Bank, and it is 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.
Have a story to add? Email us at info@economicliberties.us.
This data was last updated April 11, 2024.
| Date | Category | Abuse | Details |
|---|---|---|---|
| 1/7/2025 | Denial of Care | UHG interrupted a pre-approved breast reconstruction surgery to demand additional justification | Dr. Elisabeth Potter, a plastic surgeon who specializes in a microsurgical breast reconstruction surgery technique, posted a video on social media recounting UHG’s demand for more information about a breast cancer patient’s diagnosis and inpatient stay for a pre-approved surgery. The demand resulted in Dr. Potter having to pause the surgery and scrub out “while the patient was already asleep on the operating table.” “It’s beyond frustrating and, frankly unacceptable,” she wrote. “Patients and providers deserve better than this. |
| 1/2/2025 | Upcoding and Overbilling, Denial of Care | Using a series of maneuvers, UHG racked up billions of dollars in Medicare Advantage overpayments | A yearlong Wall Street Journal investigation found that UHG and other giant insurers diagnosed Medicare Advantage patients with conditions that made them more money; dispatched their own nurses to visit patients at home to add to these lucrative diagnoses; and aggressively recruited veterans and other patients who received some or all of their health care elsewhere, allowing the insurers to pocket premiums. The investigation also found that UHG provided its doctors with checklists of possible diagnoses and then paid them bonuses for completing them. |
| 12/31/2024 | Corrupt Practices | UHG-owned insurance companies ordered to pay $165 million for deceptive sales scheme | A Massachusetts judge ordered three UHG-owned insurance companies to pay more than $165 million in restitution and civil penalties for misleading vulnerable consumers looking to purchase traditional health insurance into buying low-value supplemental products, among other allegations. The Massachusetts attorney general’s office filed the lawsuit in December 2020. |
| 12/13/2024 | Denial of Care | UHG denied critical treatment for kids with autism | A ProPublica investigation found that UnitedHealthcare, the insurance subsidiary of UHG, “is culling providers of applied behavior analysis,” a specialized therapy for children with autism that it acknowledged is the gold standard, “and scrutinizing the medical necessity of therapy.” Their goal? To limit spending on care that is increasingly in demand as more children are diagnosed with autism. |
| 11/19/2024 | Denial of Care | UHG denied mental health care to patients | A ProPublica investigation found that UHG continues to use an algorithm to deny care to patients and payment to providers whom it deemed were receiving or providing too much therapy –– even after three states had deemed the algorithm program illegal. |
| 10/21/2024 | Upcoding and Overbilling | UHG’s dubious health risk assessments continue to inflate Medicare Advantage payments | A federal watchdog report found that UHG received more than $3.7 billion from Medicare in 2023 for in-home visits that resulted in diagnoses but no follow-up treatment, more than twice as much as any other Medicare Advantage insurer. |
| 9/20/2024 | Anticompetitive Steering of Patients and Providers | FTC sues “Big Three” PBMs, including UHG’s OptumRx, for inflating insulin prices | The Federal Trade Commission sued OptumRx, along with CVS Caremark and Express Scripts, for allegedly engaging in anticompetitive and illegal rebating practices that inflate the list price of brand-name insulin drugs and impede patient access to cheaper generic alternatives. FTC Bureau of Competition Deputy Director Rahul Rao said the suit is a preliminary step toward “fixing a broken system – a fix that could ripple beyond the insulin market and restore health competition to drive down drug prices for consumers.” |
| 9/19/2024 | Corrupt Practices | UHG’s Optum continues mass layoffs | OptumCare, a management services organization headquartered in Baskin Ridge, New Jersey, posted a notice that it plans to lay off 160 employees in December 2024 and January 2025. The notice follows several rounds of Optum layoffs and clinic closures around the country. An administrative source told the Examiner News, which covers New York’s Hudson Valley, that Optum acquired too many medical practices too fast, leading to the layoffs. |
| 9/18/2024 | Corrupt Practices | UHG settles employee retirement plan class-action lawsuit | UHG agreed to a tentative settlement to resolve a class-action lawsuit alleging that the conglomerate had mismanaged its employee retirement plan to preserve a business relationship with Wells Fargo, “a critical customer and financier” for UHG. |
| 7/25/2024 | Anticompetitive Steering of Patients and Providers | UHG abandons proposed acquisitions of nine-state physician network Stewardship Health and a related company | Following intense scrutiny from the Department of Justice (DOJ) Antitrust Division, UnitedHealth Group abandoned its proposed acquisitions, which had sparked concerns of worsening care quality, rising costs, and deteriorating working conditions. |
| 6/27/2024 | Corrupt Practices | UHG’s OptumRx agrees to pay $20 million for improperly filling opioid subscriptions | UnitedHealthGroup’s subsidiary OptumRx – its PBM – settled with the Department of Justice to resolve allegations that it improperly filled opioid prescriptions in combination with other drugs, despite red flags, between April 2013 and April 2015. |
| 6/6/2024 | Corrupt Practices | UHG executives reportedly sold $17.7 million of company stock amid Change Healthcare cyberattack | Five UHG executives, including CEO Andrew Witty, unloaded company stock on the same day as the cyberattack, according to disclosures. |
| 4/11/2024 | Corrupt Practices | UHG executives reportedly sold stock before DOJ antitrust investigation became public | Bloomberg reported that UnitedHealth Group’s chairman and three executives sold $101.5 million of company stock between Oct. 16, 2023, after reportedly learning of the DOJinvestigation, and Feb. 26, 2024, when the probe became public. |
| 3/22/2024 | Patient Privacy Violation | UHG uses patients’ claims data to target loans to providers | UnitedHealth 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. |
| 3/18/2024 | Upcoding and Overbilling | UHG whistleblower alleges that Optum Tri-State/Optum East – a subsidiary of UHG – overbills the federal government by overdiagnosing patients | According 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. |
| 3/15/2024 | Anticompetitive Steering of Patients and Providers | UHG’s 2023 financials reveal the company skirting federal regulations requiring spending on patient care by shifting money between divisions of the company | The 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. |
| 3/14/2024 | Patient Privacy Violation | Following cybersecurity breach, UHG’s Change Healthcare fails to protect personal information | On 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. |
| 11/24/2023 | Anticompetitive Steering of Patients and Providers | UHG’s Optum allegedly pushed a group of hospitals and physicians to enter an illegal agreement to not compete for primary care physicians | Emanate 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 Care | UHG’s Optum bought and utilized NaviHealth to deny patients’ necessary care | UnitedHealth 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. |
| 11/8/2023 | Denial of Care | UHG’s UnitedHealthcare regularly and illegally refuses to promptly hand over records to patients who had claims denied | According 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. |
| 10/19/2023 | Denial of Care | UHG’s UnitedHealthcare has violated state laws that require insurers to cover certain procedures and medications | In 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. |
| 8/1/2023 | Denial of Care | UHG subsidiary UMR faces Department of Labor lawsuit for denying claims based on diagnostic codes rather than patient need | UnitedHealth 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. |
| 6/1/2023 | Denial of Care | UHG’s UnitedHealthcare requires advanced notification requirement for colonoscopy care | The 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. |
| 5/2/2023 | Anticompetitive Steering of Patients and Providers | UnitedHealthcare required to pay $91.2 million for underpayment of essential medical care | Envision 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. |
| 2/2/2023 | Denial of Care | UHG’s UnitedHealthcare ignores doctors’ advice and denies claims for services they deem not “medically necessary” to reduce spending on care and increase profits | In 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. |
| 12/21/2022 | Anticompetitive Steering of Patients and Providers | UHG’s UnitedHealthcare accused of underpaying out-of-network providers | UnitedHealthcare 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. |
| 11/21/2022 | Upcoding and Overbilling | CMS finds that UnitedHealthcare has extracted overpayments from the federal government | Between 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. |
| 10/8/2022 | Upcoding and Overbilling | DOJ, 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 program | The 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 rate | Envision 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. |
| 2/24/2022 | Upcoding and Overbilling | UHG’s OptumRx fails to follow worker’s compensation prescription pricing procedures | UHG’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. |
| 8/12/2021 | Upcoding and Overbilling, Anticompetitive Steering of Patients and Providers, and Denial of Care | UHG’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 patients | UHG’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 |
| 4/6/2020 | Anticompetitive Steering of Patients and Providers | UHG’s United Behavioral Health accused of underpaying out-of-network providers | UnitedHealth 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. |
| 2/23/2020 | Anticompetitive Steering of Patients and Providers | UnitedHealthcare drops non-affiliated doctors to force patients to visit UHG-owned providers | UHG’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. |
| 6/1/2017 | Upcoding and Overbilling | CMS requests nearly $800,000 in refunds from UHG overpayment | A 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. |
| 5/16/2017 | Upcoding and Overbilling | DOJ accuses UHG of failing to remove invalid diagnoses after becoming aware of them, and telling workers to mine old medical records for additional illnesses | The 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. |