UnitedHealth Pledges Operational Changes Following Independent Audits
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UnitedHealth Group Inc. has announced a sweeping commitment to operational changes following the first results of independent audits conducted by outside consulting firms. The healthcare giant, led by CEO Stephen Hemsley, has adopted 23 distinct "action plans" designed to improve transparency and standardize internal processes across its health services and pharmacy benefit units.
The initiative comes as the company seeks to rebuild trust with the public following a period of intense scrutiny over insurer business tactics and rising medical costs. Hemsley, who took over as CEO in May, promised these reviews after the company missed profit expectations for the first time since 2008. According to the company, 65% of these corrective actions will be completed by the end of 2025, with 100% finalized by the end of the first quarter of 2026.
Focus on Medicare and Pharmacy Benefits The audits, performed by FTI Consulting and Analysis Group, highlighted several areas for improvement:
Medicare Advantage: FTI Consulting evaluated UnitedHealthcare’s risk assessment and care management programs. While the firm found the company scored well against peers, it identified slow decision-making on authorizations and a lack of standardized documentation in programs like HouseCalls, which helps determine government payments.
Pharmacy Benefits (OptumRx): Analysis Group reviewed how OptumRx manages manufacturer discounts. Although the framework was deemed "industry leading," the audit recommended increased automation and more formal policies for resolving nonpayment disputes with drugmakers.
Ongoing Legal Scrutiny Despite the push for internal reform, UnitedHealth continues to navigate significant legal challenges. The company is currently cooperating with Department of Justice (DOJ) investigations into its Medicare Advantage billing practices. While the external auditors did not evaluate legal compliance, the company has pledged to share more detailed results from its medical record reviews in the first quarter of 2026 to further its goal of transparency.
The operational overhaul follows a turbulent year for the nation's largest insurer, marked by a 35% drop in share price and a leadership transition following the exit of former CEO Andrew Witty. Hemsley maintains that these assessments are a "commitment to setting a new standard of transparency" in the complex U.S. healthcare marketplace.
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UnitedHealth pledges operational changes
