When UnitedHealth Group CEO Stephen Hemsley returned to the helm of the healthcare giant earlier this year, he committed to a deep review of the company's processes in the wake of months of turmoil.
UHG posted the results of the first independent audits conducted under this effort on Friday morning, with the initial reviews focusing on risk assessments in Medicare Advantage, care services management at UnitedHealthcare and policies at Optum Rx around drug manufacturer discounts. The analyses were conducted by FTI Consulting Inc. and Analysis Group Inc.
Hemsley said in a letter to investors that the audits are just one facet of the company's broader push to be more transparent and improve organizational operations.
"We hope that you see these assessments as a commitment to setting a new standard of transparency for the health care marketplace, as we believe that you and every person who engages with our health system deserves to understand how we go about our work," he wrote.
The reports generally contained positive results, but did note that, at times, UnitedHealthcare failed to correct actions flagged in regulatory audits.
"In some of these instances, auditors identified repeat violations from prior audits or noted that corrective actions from previous examinations were not timely implemented," per the executive summary on the report. "FTI also reviewed corrective actions in addition to the nine noted by auditors and found instances in which corrective actions were not fully implemented."
The auditors found that UHC and Optum both largely keep robust documentation on MA risk adjustment efforts and were generally able to respond and adjust to changes from the Centers for Medicare & Medicaid Services. There was also routine oversight in place for both UnitedHealthcare and Optum on risk adjustment, per the report.
The analyses also found that Optum Rx generally deploys a "comprehensive and well-structured framework that governs all stages of manufacturer discount administration."
Based on the results, UnitedHealth Group has outlined multiple steps it plans to take to improve operations. The company's Internal Audit & Advisory Services team has identified 23 action plans across different business lines to generate improvements, Hemsley said in the letter.
He said a number of these action plans have already been implemented, and the company expects that all of them will be completed by the end of the first quarter in 2026.
Key steps include ensuring relevant risk adjustment policies and procedures are reviewed annually, and developing an overarching policy for chart review and data submission across the board. The company also said it intends to develop new governance policies for Optum's HouseCalls program, which has come under fire as a source of "upcoding" for the insurer.
As for care services management improvements at UHC, the company said it will ensure that audit recommendations are fully remedied and dive into tracking processes across the insurance division to facilitate those remedies.
And at Optum Rx, the company said it plans to investigate ways to automate low-complexity, but high-volume discounts, and find ways to streamline policy and procedure documentation.
"Please keep in mind that this work is just one aspect of a broader commitment to transparency and continuous improvement throughout our organization," Hemsley said. "We know that our actions and decisions have significant impacts on patients, care providers and the broader health system, and we are determined to hold ourselves to the highest standard."