NEW YORK, Dec 19 (Reuters) – UnitedHealth said on Friday that audits by outside consulting firms of its health services and pharmacy benefit units would result in operational changes including more automation and increased standardization of internal processes.
UnitedHealth Group Inc CEO Stephen Hemsley promised the review of the company’s businesses earlier this year after the company missed its own profit expectations for the first time since 2008.
During a first-quarter earnings conference call, executives attributed the shortfall to government reimbursement pressures and an unfavorable mix of new patients in Optum Health.
UnitedHealth provides clinical services through Optum Health and also operates pharmacy benefit manager OptumRx and insurer UnitedHealthcare.
“The work is already well underway. Several action plans have already been completed,” Hemsley said in a letter sent to stakeholders on Friday, saying there were 23 such plans.
“Of the remaining actions, more than half will be finalized by the end of this year, and 100% will be finalized before the end of the first quarter next year,” he said.
FTI found that, in some instances, UnitedHealth lacked standardized documentation, including in its in‑home health assessment program, HouseCalls, which submits patient diagnoses that help determine Medicare Advantage payments to providers.
Hemsley said in the letter the company would share the results of the HouseCalls visit review in the first quarter of 2026.
UnitedHealthcare operates Medicare Advantage plans for adults 65 and older and people with disabilities on behalf of the government and has been scrutinized for payments that Optum receives from the insurer.
UnitedHealth denied wrongdoing, but said in a July filing that it is cooperating with criminal and civil Justice Department investigations into its Medicare Advantage billing practices. FTI said in its findings that it did not evaluate legal compliance.
A separate report by Analysis Group on OptumRx found that the company’s pharmacy benefit manager could benefit from standardizing audit practices and increasing process automation.
(Reporting by Amina Niasse; editing by Caroline Humer and Lincoln Feast.)
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