UnitedHealth's Overhaul: Automation and Standardization Amidst Audit Findings

UnitedHealth Group is undergoing operational changes to enhance automation and standardization following audits of its health services and pharmacy benefit units. CEO Stephen Hemsley initiated the review after profit expectations fell short. The company is cooperating with Justice Department investigations, and action plans are underway to address operational shortcomings.

UnitedHealth Group has announced significant operational overhauls following external audits of its health services and pharmacy benefit units. These changes aim to increase automation and standardize internal processes, a strategic move prompted by the company's recent profit shortfall, marking the first miss since 2008.

CEO Stephen Hemsley confirmed numerous action plans are already in progress, with more than half expected to be completed by year-end. Auditing firm FTI's insights highlighted the need for improved documentation in programs like HouseCalls, which impacts Medicare Advantage payments. The results of the HouseCalls review will be disclosed by early 2026.

The company is also addressing ongoing Justice Department investigations concerning its Medicare Advantage billing practices, although it denies any wrongdoing. Concurrently, another report suggested OptumRx could enhance operations through more efficient audit practices and increased automation.

(With inputs from agencies.)