A new study suggests insurance giant UnitedHealthcare is paying its sister company Optum's physicians more than it pays other providers.
The analysis, published this week in Health Affairs, examines price transparency data made available through Turquoise Health's platform across 14 CPT codes. The total sample includes more than 385,000 transactions, with 705 of those representing observations directly between UHC and Optum.
Based on those data, the researchers found UnitedHealthcare paid 17% more to Optum than to other providers. In markets where UHC has a market share of 25% or more, payments were 61% higher.
"The results suggest that intercompany transactions within healthcare conglomerates may warrant scrutiny, as they may be signals of regulatory gaming or attempted foreclosure," the Brown University and University of California, Berkeley-based researchers wrote.
UnitedHealth Group, the parent company of UHC and Optum, disputed the findings, pointing out the small sample size and limited number of codes analyzed.
"UnitedHealthcare pays Optum Health consistent with other providers in the market, which is essential for staying competitive," the company said in a statement to Fierce Healthcare. "The study, funded by groups with known biases, cherry-picks data and is flat-out wrong."
The research was backed by Arnold Ventures and the Commonwealth Fund, per the report. The American Hospital Association has also sparred on multiple occasions with Arnold Ventures over research the venture fund has supported.
The report also noted that UnitedHealthcare broadly paid providers more than other insurers, with its payments to non-Optum physicians 38% above other major firms.
UHG is, through Optum, one of the country's largest employers of physicians, and, while other major healthcare companies do similarly have provider arms, Optum's is by far the biggest. The researchers wrote that this is why they centered the analysis on UnitedHealth, though the implications likely extend to other companies.
A separate analysis released earlier this year in Health Affairs suggests that insurers may be able to use these provider relationships to game medical loss ratio requirements. Under these laws, payers are required to spent the bulk of their premium revenue on medical care.
Paying a larger sum to an affiliated provider would, in theory, allow a payer to meet those requirements while keeping that revenue within the same broader corporation, according to the article from experts at consulting firm Bailit Health Purchasing.
The researchers for the new study also argue that this potential gamesmanship could extend to pharmacy benefits, specialty pharmacy and other segments within a large conglomerate, and that warrants further and broader investigation.
"As UnitedHealth Group (via Optum) and other insurers acquire physician practices and grow their pharmacy benefit manager and specialty pharmacy businesses, particularly in markets with little insurance competition, it is important to monitor how intercompany transactions may mask monopoly profits because that would interfere with market signals for entry and hinder regulatory enforcement of the medical loss ratio," they wrote.