Health Insurance Issues: Data & Reports
This section compiles reports, studies, and articles detailing the systemic problems within the health insurance industry, particularly concerning wrongful denials and their impact.
Table of Contents
- Systemic Denial Practices
- Legal Challenges & Lawsuits
- Government Investigations & Scrutiny
- Market Power & Hospital Conflicts
- Drug Pricing & PBM Issues
- Whistleblower Accounts & Patient Stories
- The Human Cost & Public Reaction
- External Health Insurance Watchlists & Resources
- The Rise of the Health Care Influencers
Systemic Denial Practices
Medicare Advantage Insurers Made Nearly 50 Million Prior Authorization Determinations in 2023
A KFF analysis of new federal data found that Medicare Advantage insurers processed a staggering 49.8 million prior authorization requests in 2023. This is a massive increase from 37 million in 2021 and averages out to more than 4 requests for every single MA enrollee.
- Insurers denied 3.7 million of these requests in 2023. Even more alarming, only 11.7% of those denials were appealed by patients. For the tiny fraction of denials that were appealed, 81.7% were overturned in the patient's favor, suggesting that millions of initial denials for necessary care were improper.
- United Healthcare was Above Average at 85.2%, Cigna 86%, CVS 89.7%, and Centene the worst at their job having 93.6% of their denials overturned. Only 6.4% of were upheld when exposed to third-party scrutiny.
- Total prior authorization requests processed: 49.8 million
- Total requests denied: 3.7 million (7% of all requests)
- If 81.7% of the 3.7 million denied are as wrongful as those that were appealed that is 3 Million Victims of the Denial Echo Chamber per Year.
- This is Forcing Healthcare Providers into Learned Helplessness, Patients and taxpayers are paying Interest on Health Insurance's Practice of Medicine without a License to Abusively and Discriminately Restrain or Prevent Patient Treatment, all for the sake of Corporate Profits.
- Services with high denial rates included home health (15%) and skilled nursing facility stays (12%).
Claims Denials and Appeals in ACA Marketplace Plans in 2023
Insurers on the ACA Marketplace (HealthCare.gov) denied 19% of all in-network claims in 2023. This means nearly 1 in 5 medical services that were already performed by an in-network doctor were retroactively denied payment by the insurance company. United Healthcare was above Average with 33%.
- Consumers almost never appeal these denials. Of the 73 million in-network claims that were denied, consumers filed a formal appeal for less than 1% of them. When they did appeal, insurers upheld their own original denial 56% of the time.
- Insurers processed 425 million claims in 2023, denying 73 million in-network claims.
- The most common reason given for a denial was a vague "Other" reason (34%), followed by "Administrative reason" (18%).
- Only 6% of denials were based on a lack of medical necessity.
- Denial rates varied wildly by insurer; for example, Blue Cross Blue Shield of Alabama denied 35% of in-network claims, while UnitedHealth Group denied 33%.
Consumer Survey Highlights Problems with Denied Health Insurance Claims
A KFF survey of insured adults found that nearly 1 in 5 (18%) reported having a claim denied in the past year. For those who experienced a denial, only 29% reported that their "biggest problem" with their insurance was ultimately resolved to their satisfaction.
- Denied claims have a direct and negative impact on health. Among patients who experienced a denied claim, 24% said their health declined as a result, and 24% said they were unable to receive care recommended by their doctor.
- 58% of all insured adults reported experiencing at least one problem with their insurance in the past year (including denials, network issues, or prior authorization problems).
- Denials were most common for those with employer-sponsored plans (21%) and marketplace plans (20%).
- The vast majority of consumers who had a claim denied did not know their rights: 69% did not know they could appeal, and 86% did not know what government agency to call for help.
Legal Challenges & Lawsuits
Ballad Health Sues UnitedHealth Group, Alleging Medicare Advantage Manipulation and Harm to Patients
Ballad Health has filed a federal lawsuit against UnitedHealth Group, alleging the insurer systematically denies, delays, or underpays for medically necessary care for patients enrolled in Medicare Advantage plans. This is the first time Ballad Health has taken legal action against an insurance company, calling it a "last resort" after years of failed attempts to resolve the issues.
- The lawsuit alleges that UnitedHealth improperly uses a "blatantly flawed" artificial intelligence (AI) model to override the medical judgments of treating physicians and prematurely deny coverage for post-acute care. This practice leaves patients hospitalized for longer than necessary, increasing their risk of hospital-acquired conditions and straining hospital capacity.
- The lawsuit claims UnitedHealth has withheld "millions of dollars" it had previously agreed to pay Ballad Health for patient care. The suit also references a pattern of behavior cited in national reports, alleging that UnitedHealth overstates how sick patients are to collect higher government payments while simultaneously denying claims for necessary care.
Read the WJHL's Article →
Estate of Gene B. Lokken et al. v. UnitedHealth Group, Inc. et al.
This is a federal class-action lawsuit filed by the estates of deceased Medicare Advantage patients alleging UnitedHealth Group (UHG) and its subsidiary naviHealth illegally used an Artificial Intelligence (AI) model to deny post-acute care to elderly patients. A federal judge has allowed the case to proceed on claims of breach of contract and breach of the implied covenant of good faith and fair dealing.
- The lawsuit alleges the AI model, known as "nH Predict," is "notoriously inaccurate" with an error rate over 90%. The suit claims UHG knew of these flaws but used the algorithm to override physicians' recommendations and deny necessary care, forcing elderly patients to either pay out-of-pocket or forgo care, leading to "worsening injury, illness, or death".
- The lawsuit alleges that UHG knows only a "tiny minority" of policyholders (estimated at 0.2%) will appeal the AI-powered denials.
- Plaintiffs allege that when a denial is appealed, over 90% of them are reversed, demonstrating the AI model's blatant inaccuracy.
- The suit also claims UHG employees were disciplined or terminated if they deviated from the AI's "rigid and unrealistic" predictions, regardless of the patient's actual medical needs.
Read the Healthcare Litigation Tracker page →
Judge rips insurance company for ‘immoral, barbaric’ cancer denials
A federal judge recused himself from hearing a case where UnitedHealthcare denied coverage for proton beam therapy to a child with cancer, revealing that he himself had been diagnosed with cancer and initially denied the same treatment by his own insurance company.
- The judge's personal experience, where his insurer denied a potentially life-saving treatment recommended by doctors (later approved after appeal), mirrored the plaintiff's situation so closely that he felt he could no longer be impartial, highlighting the deeply personal and potentially devastating impact of such denials.
- The judge, Robert W. Schroeder III, was diagnosed with base-of-tongue cancer in 2018.
- His initial request for proton beam therapy was denied by his insurance company but was later approved after an appeal.
- The case he recused himself from involved A.F., a child diagnosed with Ewing sarcoma, whose UnitedHealthcare plan denied proton beam therapy.
Ballad Health Sues UnitedHealth Group, Alleging Medicare Advantage Manipulation and Harm to Patients
Ballad Health has filed a federal lawsuit against UnitedHealth Group, alleging the insurer systematically denies, delays, or underpays for medically necessary care for patients enrolled in Medicare Advantage plans. This is the first time Ballad Health has taken legal action against an insurance company, calling it a "last resort" after years of failed attempts to resolve the issues.
- The lawsuit alleges that UnitedHealth improperly uses a "blatantly flawed" artificial intelligence (AI) model to override the medical judgments of treating physicians and prematurely deny coverage for post-acute care. This practice leaves patients hospitalized for longer than necessary, increasing their risk of hospital-acquired conditions and straining hospital capacity.
- The lawsuit claims UnitedHealth has withheld "millions of dollars" it had previously agreed to pay Ballad Health for patient care. The suit also references a pattern of behavior cited in national reports, alleging that UnitedHealth overstates how sick patients are to collect higher government payments while simultaneously denying claims for necessary care.
Estate of Gene B. Lokken et al. v. UnitedHealth Group, Inc. et al.
This is a federal class-action lawsuit filed by the estates of deceased Medicare Advantage patients alleging UnitedHealth Group (UHG) and its subsidiary naviHealth illegally used an Artificial Intelligence (AI) model to deny post-acute care to elderly patients. A federal judge has allowed the case to proceed on claims of breach of contract and breach of the implied covenant of good faith and fair dealing.
- The lawsuit alleges the AI model, known as "nH Predict," is "notoriously inaccurate" with an error rate over 90%. The suit claims UHG knew of these flaws but used the algorithm to override physicians' recommendations and deny necessary care, forcing elderly patients to either pay out-of-pocket or forgo care, leading to "worsening injury, illness, or death".
- The lawsuit alleges that UHG knows only a "tiny minority" of policyholders (estimated at 0.2%) will appeal the AI-powered denials.
- Plaintiffs allege that when a denial is appealed, over 90% of them are reversed, demonstrating the AI model's blatant inaccuracy.
- The suit also claims UHG employees were disciplined or terminated if they deviated from the AI's "rigid and unrealistic" predictions, regardless of the patient's actual medical needs.
Judge rips insurance company for ‘immoral, barbaric’ cancer denials
A federal judge recused himself from hearing a case where UnitedHealthcare denied coverage for proton beam therapy to a child with cancer, revealing that he himself had been diagnosed with cancer and initially denied the same treatment by his own insurance company.
- The judge's personal experience, where his insurer denied a potentially life-saving treatment recommended by doctors (later approved after appeal), mirrored the plaintiff's situation so closely that he felt he could no longer be impartial, highlighting the deeply personal and potentially devastating impact of such denials.
- The judge, Robert W. Schroeder III, was diagnosed with base-of-tongue cancer in 2018.
- His initial request for proton beam therapy was denied by his insurance company but was later approved after an appeal.
- The case he recused himself from involved A.F., a child diagnosed with Ewing sarcoma, whose UnitedHealthcare plan denied proton beam therapy.
Government Investigations & Scrutiny
FTC Accuses CVS, Cigna, UnitedHealth of Abusing Middleman Role
The Federal Trade Commission (FTC) formally accused the pharmacy benefit manager (PBM) units of CVS Health (Aetna), Cigna Group (Express Scripts), and UnitedHealth Group (Optum Rx) of engaging in anticompetitive practices that inflate drug costs and restrict patient access to medicines. This follows a nearly two-year investigation into the PBM industry.
- The FTC alleges these powerful PBMs leverage their dominant market position to steer patients towards their own affiliated pharmacies, limit choices for employers and patients, and demand rebates and fees from drugmakers in ways that ultimately drive up costs for consumers rather than lowering them.
- The three companies (CVS/Caremark, Cigna/Express Scripts, UnitedHealth/Optum Rx) control approximately 80% of the PBM market.
- The FTC's vote to issue the accusations and potentially pursue litigation was 3-0.
- The investigation involved compulsory orders demanding information and records from these PBMs.
- Specific allegations include using complex contracts, rebates, and fees to disadvantage competitors and increase PBM profits at the expense of patients and payers.
Read the Bloomberg Article →
DOJ Interviewing Former Employees About Medicare Billing Practices at UnitedHealth: WSJ
The U.S. Department of Justice (DOJ) is actively investigating UnitedHealth Group's Medicare Advantage billing practices, with investigators now interviewing former employees, particularly those involved in coding patient diagnoses. This indicates a potentially deepening phase of the probe into how the company determines patient risk scores for payment.
- The investigation centers on allegations of "upcoding"—whether UnitedHealth used practices like in-home health assessments and chart reviews primarily to add diagnoses (sometimes irrelevant or inaccurate ones) to make patients appear sicker, thereby improperly inflating the risk adjustment payments received from Medicare by potentially billions of dollars.
- The investigation focuses on Medicare Advantage risk adjustment practices.
- Previous reporting cited in the article (e.g., by the Wall Street Journal) suggested these practices could have led to $8.7 billion in extra Medicare payments in 2021 alone. Taken from American Tax Payers.
- Investigators are specifically targeting former employees who worked in roles related to coding and risk adjustment.
- UnitedHealth has stated it is cooperating with the DOJ and defends its practices as compliant and aimed at accurate diagnoses. As the Investigation looks more like a Crimes Against Humanity Crisis.
Too big to fail? Lawmakers are eyeing a breakup of UnitedHealth Group
Driven by growing concerns over UnitedHealth Group's (UHG) immense size, market dominance, and alleged anticompetitive practices stemming from its vertical integration, U.S. lawmakers and regulators (including potentially the DOJ and FTC) are seriously considering antitrust action, including the possibility of breaking up the healthcare giant.
- UHG's control over vast swaths of the healthcare system—from insurance (UnitedHealthcare) and pharmacy benefits (Optum Rx) to employing doctors (Optum Care) and owning critical data infrastructure (Optum Insight/Change Healthcare)—gives it unparalleled power to potentially manipulate markets, stifle competition from independent providers, dictate prices, and limit patient choice, raising fears of systemic harm to the U.S. healthcare system.
- UHG's Optum division employs or is affiliated with roughly 90,000 physicians, making it the largest employer of doctors in the U.S.
- UHG controls about 15% of the outpatient surgery market through Optum.
- Optum Rx is one of the top three PBMs, controlling a massive share of the prescription drug market.
- Concerns focus on UHG steering patients to its own providers/pharmacies, using patient data anti-competitively, and acquiring competitors (like Change Healthcare) to consolidate power.
Read the StatNews Article →
UnitedHealth Medicare Advantage Fraud Investigation
The U.S. Department of Justice (DOJ) is conducting a civil fraud investigation into UnitedHealth Group's (UHG) Medicare Advantage billing practices. The probe focuses on whether UHG improperly inflated payments by diagnosing patients with conditions, often through in-home health risk assessments (HRAs) and chart reviews, that were not medically relevant or accurate, a practice known as "upcoding".
- The investigation alleges that UHG knowingly submitted false claims by diagnosing beneficiaries with conditions they did not actually have or were not being treated for, solely to increase the risk adjustment payments received from Medicare. This practice potentially defrauded taxpayers of billions and prioritized profits over accurate patient health assessments.
- A Health and Human Services Office of Inspector General (HHS OIG) report found UHG received over $3.7 billion from Medicare in 2023 for diagnoses made during in-home HRAs and chart reviews that lacked follow-up treatment.
- The HHS OIG noted UHG received more money from these specific types of diagnoses (HRAs and chart reviews only) than any other Medicare Advantage Organization (MAO).
- Senator Chuck Grassley cited reports that UHG's inappropriate diagnoses resulted in $8.7 billion in extra Medicare payments in 2021 alone.
Read the RescueMeds Article →
Following Ryan's Call, Department of Justice Launches Investigation into UnitedHealth; Despite Billions in Alleged Fraud, Company Announces Delayed Staff Reductions
The Department of Justice (DOJ) has launched an investigation into UnitedHealth Group's Medicare billing practices, following calls from lawmakers like Rep. Pat Ryan. This investigation comes shortly after UnitedHealth announced staff reductions, despite allegations of defrauding taxpayers out of billions through improper Medicare Advantage billing.
- Rep. Ryan highlights the apparent contradiction of UnitedHealth cutting staff and potentially impacting patient care access, even while facing allegations of massive fraud ("billions") related to overbilling Medicare by making patients seem sicker than they are ("upcoding") through practices like in-home assessments. He calls the alleged behavior "deeply disturbing" and potentially harmful to both taxpayers and seniors needing care.
- The investigation targets UnitedHealth Group's Medicare Advantage billing and coding practices.
- Allegations involve potential "upcoding" and improper use of Health Risk Assessments (HRAs) to inflate Medicare payments.
- Previous reports (cited by Sen. Grassley and HHS OIG) suggested these practices may have cost taxpayers billions annually (e.g., potentially $8.7 billion in extra payments in 2021 alone).
Read Congressman Pat Ryan's May 20, 2025 Press Release →
Justice Department Sues to Block UnitedHealth Group's Acquisition of Home Health and Hospice Provider Amedisys
The U.S. Department of Justice (DOJ), along with the Attorneys General of Minnesota and New York, filed a civil antitrust lawsuit to block UnitedHealth Group's (UHG) proposed acquisition of Amedisys Inc. The suit alleges that the merger would violate Section 7 of the Clayton Act by substantially lessening competition in the home health services market in numerous states.
- The DOJ argues that allowing UHG's Optum division, which already owns LHC Group (another major home health provider), to acquire Amedisys would harm vulnerable patients, including seniors and individuals with disabilities who rely on home health care. The acquisition could lead to higher prices, lower quality of care, reduced access to services, less innovation, and depressed wages for home health workers.
- Acquisition Target: Amedisys Inc., a provider operating in 37 states and the District of Columbia.
- Acquirer: UnitedHealth Group (via its Optum division).
- Market Concern: Home health services, particularly affecting Medicare Advantage enrollees.
- Alleged Harm: Reduced competition, potentially leading to increased costs, decreased quality and access, and suppressed worker wages.
- Existing UHG Holding: Optum already owns LHC Group, a significant competitor to Amedisys in many markets.
Read the DOJ Nov 12, 2024 Press Release →
United States et al. v. UnitedHealth Group, Incorporated, et al.; Proposed Final Judgment and Competitive Impact Statement
This document outlines the settlement (Proposed Final Judgment) reached between the Department of Justice (DOJ), UnitedHealth Group (UHG), and Change Healthcare. To resolve antitrust concerns raised by the DOJ, UHG agreed to divest Change Healthcare's claims editing business, known as ClaimsXten, to the private equity firm TPG Capital, allowing the main acquisition of Change by UHG to proceed.
- The DOJ's original lawsuit aimed to block the acquisition entirely because it alleged that allowing UHG (a major health insurer) to acquire Change Healthcare (a crucial source of healthcare claims processing technology and data for rival insurers) would give UHG unfair access to its competitors' competitively sensitive information, potentially harming competition in health insurance markets across the U.S.. The divestiture of ClaimsXten was deemed necessary to prevent this competitive harm.
- Acquisition: UnitedHealth Group's acquisition of Change Healthcare Inc..
- Divestiture: UHG was required to sell Change Healthcare's claims editing business, ClaimsXten, to TPG Capital.
- Antitrust Concern: UHG gaining access to competitively sensitive data of rival health insurers through Change's services.
- Legal Basis: The lawsuit alleged the merger violated Section 7 of the Clayton Act.
Read the United States National Archives →
Attorney General James Takes Action to Protect Access to Health Services in Western New York from UnitedHealthcare
New York Attorney General Letitia James filed a lawsuit seeking a court order to prevent UnitedHealthcare (UHC) from terminating its contracts with Catholic Health System (CHS) in Western New York. The AG argues that allowing UHC to end the contracts would significantly harm healthcare access for thousands of New Yorkers by removing CHS hospitals and providers from UHC's network.
- The termination would disproportionately affect vulnerable populations, including seniors on Medicare Advantage plans and low-income individuals, leaving them without in-network access to critical care providers they rely on. Attorney General James alleges this action violates UHC's obligations to maintain adequate provider networks and constitutes irresponsible corporate behavior that prioritizes profits over patient well-being.
- The contract termination was set to affect thousands of UnitedHealthcare members in Western New York.
- Catholic Health System is a major provider in the region, including hospitals like Mercy Hospital of Buffalo, Kenmore Mercy Hospital, and Sisters of Charity Hospital.
- Affected plans include UnitedHealthcare's commercial plans and Medicare Advantage plans.
- The lawsuit seeks to compel UHC to negotiate in good faith and prevent the immediate disruption of care for patients.
Read the Attorney General of New York's Aug 7, 2025 Press Release →
Senate Democrats release scathing report on Medicare Advantage denials
A Senate investigation into the three largest Medicare Advantage insurers (UnitedHealthcare, Humana, and CVS Health's Aetna) found that the companies deny prior authorization requests for post-acute care at far higher rates than for other types of care.
- In 2022, Humana denied prior authorization requests for post-acute care at a rate that was more than 16 times higher than its overall denial rate for all types of prior authorization requests.
- UnitedHealthcare's prior authorization denial rate for post-acute care more than doubled from 10.9% in 2020 to 22.7% in 2022.
- Humana's denial rate for long-term acute care hospitals (a form of post-acute care) grew by 54% between 2020 and 2022.
- The number of post-acute care service requests at CVS Health that required prior authorization increased by 57.5% from 2019 to 2022.
- In 2022, both UnitedHealthcare and CVS denied post-acute care requests at rates about three times higher than their denial rates for all types of requests combined.
Read the Washington State Hospital Association Article →
FTC Accuses CVS, Cigna, UnitedHealth of Abusing Middleman Role
The Federal Trade Commission (FTC) formally accused the pharmacy benefit manager (PBM) units of CVS Health (Aetna), Cigna Group (Express Scripts), and UnitedHealth Group (Optum Rx) of engaging in anticompetitive practices that inflate drug costs and restrict patient access to medicines. This follows a nearly two-year investigation into the PBM industry.
- The FTC alleges these powerful PBMs leverage their dominant market position to steer patients towards their own affiliated pharmacies, limit choices for employers and patients, and demand rebates and fees from drugmakers in ways that ultimately drive up costs for consumers rather than lowering them.
- The three companies (CVS/Caremark, Cigna/Express Scripts, UnitedHealth/Optum Rx) control approximately 80% of the PBM market.
- The FTC's vote to issue the accusations and potentially pursue litigation was 3-0.
- The investigation involved compulsory orders demanding information and records from these PBMs.
- Specific allegations include using complex contracts, rebates, and fees to disadvantage competitors and increase PBM profits at the expense of patients and payers.
DOJ Interviewing Former Employees About Medicare Billing Practices at UnitedHealth: WSJ
The U.S. Department of Justice (DOJ) is actively investigating UnitedHealth Group's Medicare Advantage billing practices, with investigators now interviewing former employees, particularly those involved in coding patient diagnoses. This indicates a potentially deepening phase of the probe into how the company determines patient risk scores for payment.
- The investigation centers on allegations of "upcoding"—whether UnitedHealth used practices like in-home health assessments and chart reviews primarily to add diagnoses (sometimes irrelevant or inaccurate ones) to make patients appear sicker, thereby improperly inflating the risk adjustment payments received from Medicare by potentially billions of dollars.
- The investigation focuses on Medicare Advantage risk adjustment practices.
- Previous reporting cited in the article (e.g., by the Wall Street Journal) suggested these practices could have led to $8.7 billion in extra Medicare payments in 2021 alone. Taken from American Tax Payers.
- Investigators are specifically targeting former employees who worked in roles related to coding and risk adjustment.
- UnitedHealth has stated it is cooperating with the DOJ and defends its practices as compliant and aimed at accurate diagnoses. As the Investigation looks more like a Crimes Against Humanity Crisis.
Too big to fail? Lawmakers are eyeing a breakup of UnitedHealth Group
Driven by growing concerns over UnitedHealth Group's (UHG) immense size, market dominance, and alleged anticompetitive practices stemming from its vertical integration, U.S. lawmakers and regulators (including potentially the DOJ and FTC) are seriously considering antitrust action, including the possibility of breaking up the healthcare giant.
- UHG's control over vast swaths of the healthcare system—from insurance (UnitedHealthcare) and pharmacy benefits (Optum Rx) to employing doctors (Optum Care) and owning critical data infrastructure (Optum Insight/Change Healthcare)—gives it unparalleled power to potentially manipulate markets, stifle competition from independent providers, dictate prices, and limit patient choice, raising fears of systemic harm to the U.S. healthcare system.
- UHG's Optum division employs or is affiliated with roughly 90,000 physicians, making it the largest employer of doctors in the U.S.
- UHG controls about 15% of the outpatient surgery market through Optum.
- Optum Rx is one of the top three PBMs, controlling a massive share of the prescription drug market.
- Concerns focus on UHG steering patients to its own providers/pharmacies, using patient data anti-competitively, and acquiring competitors (like Change Healthcare) to consolidate power.
UnitedHealth Medicare Advantage Fraud Investigation
The U.S. Department of Justice (DOJ) is conducting a civil fraud investigation into UnitedHealth Group's (UHG) Medicare Advantage billing practices. The probe focuses on whether UHG improperly inflated payments by diagnosing patients with conditions, often through in-home health risk assessments (HRAs) and chart reviews, that were not medically relevant or accurate, a practice known as "upcoding".
- The investigation alleges that UHG knowingly submitted false claims by diagnosing beneficiaries with conditions they did not actually have or were not being treated for, solely to increase the risk adjustment payments received from Medicare. This practice potentially defrauded taxpayers of billions and prioritized profits over accurate patient health assessments.
- A Health and Human Services Office of Inspector General (HHS OIG) report found UHG received over $3.7 billion from Medicare in 2023 for diagnoses made during in-home HRAs and chart reviews that lacked follow-up treatment.
- The HHS OIG noted UHG received more money from these specific types of diagnoses (HRAs and chart reviews only) than any other Medicare Advantage Organization (MAO).
- Senator Chuck Grassley cited reports that UHG's inappropriate diagnoses resulted in $8.7 billion in extra Medicare payments in 2021 alone.
Following Ryan's Call, Department of Justice Launches Investigation into UnitedHealth; Despite Billions in Alleged Fraud, Company Announces Delayed Staff Reductions
The Department of Justice (DOJ) has launched an investigation into UnitedHealth Group's Medicare billing practices, following calls from lawmakers like Rep. Pat Ryan. This investigation comes shortly after UnitedHealth announced staff reductions, despite allegations of defrauding taxpayers out of billions through improper Medicare Advantage billing.
- Rep. Ryan highlights the apparent contradiction of UnitedHealth cutting staff and potentially impacting patient care access, even while facing allegations of massive fraud ("billions") related to overbilling Medicare by making patients seem sicker than they are ("upcoding") through practices like in-home assessments. He calls the alleged behavior "deeply disturbing" and potentially harmful to both taxpayers and seniors needing care.
- The investigation targets UnitedHealth Group's Medicare Advantage billing and coding practices.
- Allegations involve potential "upcoding" and improper use of Health Risk Assessments (HRAs) to inflate Medicare payments.
- Previous reports (cited by Sen. Grassley and HHS OIG) suggested these practices may have cost taxpayers billions annually (e.g., potentially $8.7 billion in extra payments in 2021 alone).
Justice Department Sues to Block UnitedHealth Group's Acquisition of Home Health and Hospice Provider Amedisys
The U.S. Department of Justice (DOJ), along with the Attorneys General of Minnesota and New York, filed a civil antitrust lawsuit to block UnitedHealth Group's (UHG) proposed acquisition of Amedisys Inc. The suit alleges that the merger would violate Section 7 of the Clayton Act by substantially lessening competition in the home health services market in numerous states.
- The DOJ argues that allowing UHG's Optum division, which already owns LHC Group (another major home health provider), to acquire Amedisys would harm vulnerable patients, including seniors and individuals with disabilities who rely on home health care. The acquisition could lead to higher prices, lower quality of care, reduced access to services, less innovation, and depressed wages for home health workers.
- Acquisition Target: Amedisys Inc., a provider operating in 37 states and the District of Columbia.
- Acquirer: UnitedHealth Group (via its Optum division).
- Market Concern: Home health services, particularly affecting Medicare Advantage enrollees.
- Alleged Harm: Reduced competition, potentially leading to increased costs, decreased quality and access, and suppressed worker wages.
- Existing UHG Holding: Optum already owns LHC Group, a significant competitor to Amedisys in many markets.
United States et al. v. UnitedHealth Group, Incorporated, et al.; Proposed Final Judgment and Competitive Impact Statement
This document outlines the settlement (Proposed Final Judgment) reached between the Department of Justice (DOJ), UnitedHealth Group (UHG), and Change Healthcare. To resolve antitrust concerns raised by the DOJ, UHG agreed to divest Change Healthcare's claims editing business, known as ClaimsXten, to the private equity firm TPG Capital, allowing the main acquisition of Change by UHG to proceed.
- The DOJ's original lawsuit aimed to block the acquisition entirely because it alleged that allowing UHG (a major health insurer) to acquire Change Healthcare (a crucial source of healthcare claims processing technology and data for rival insurers) would give UHG unfair access to its competitors' competitively sensitive information, potentially harming competition in health insurance markets across the U.S.. The divestiture of ClaimsXten was deemed necessary to prevent this competitive harm.
- Acquisition: UnitedHealth Group's acquisition of Change Healthcare Inc..
- Divestiture: UHG was required to sell Change Healthcare's claims editing business, ClaimsXten, to TPG Capital.
- Antitrust Concern: UHG gaining access to competitively sensitive data of rival health insurers through Change's services.
- Legal Basis: The lawsuit alleged the merger violated Section 7 of the Clayton Act.
Attorney General James Takes Action to Protect Access to Health Services in Western New York from UnitedHealthcare
New York Attorney General Letitia James filed a lawsuit seeking a court order to prevent UnitedHealthcare (UHC) from terminating its contracts with Catholic Health System (CHS) in Western New York. The AG argues that allowing UHC to end the contracts would significantly harm healthcare access for thousands of New Yorkers by removing CHS hospitals and providers from UHC's network.
- The termination would disproportionately affect vulnerable populations, including seniors on Medicare Advantage plans and low-income individuals, leaving them without in-network access to critical care providers they rely on. Attorney General James alleges this action violates UHC's obligations to maintain adequate provider networks and constitutes irresponsible corporate behavior that prioritizes profits over patient well-being.
- The contract termination was set to affect thousands of UnitedHealthcare members in Western New York.
- Catholic Health System is a major provider in the region, including hospitals like Mercy Hospital of Buffalo, Kenmore Mercy Hospital, and Sisters of Charity Hospital.
- Affected plans include UnitedHealthcare's commercial plans and Medicare Advantage plans.
- The lawsuit seeks to compel UHC to negotiate in good faith and prevent the immediate disruption of care for patients.
Senate Democrats release scathing report on Medicare Advantage denials
A Senate investigation into the three largest Medicare Advantage insurers (UnitedHealthcare, Humana, and CVS Health's Aetna) found that the companies deny prior authorization requests for post-acute care at far higher rates than for other types of care.
- In 2022, Humana denied prior authorization requests for post-acute care at a rate that was more than 16 times higher than its overall denial rate for all types of prior authorization requests.
- UnitedHealthcare's prior authorization denial rate for post-acute care more than doubled from 10.9% in 2020 to 22.7% in 2022.
- Humana's denial rate for long-term acute care hospitals (a form of post-acute care) grew by 54% between 2020 and 2022.
- The number of post-acute care service requests at CVS Health that required prior authorization increased by 57.5% from 2019 to 2022.
- In 2022, both UnitedHealthcare and CVS denied post-acute care requests at rates about three times higher than their denial rates for all types of requests combined.
Market Power & Hospital Conflicts
Mayo Clinic to Leave Most UnitedHealthcare and Humana Medicare Advantage Networks
Effective January 1, 2026, Mayo Clinic will no longer be an in-network provider for most individual Medicare Advantage plans from UnitedHealthcare and Humana. This change will primarily affect patients at Mayo facilities in Minnesota, Wisconsin, and Iowa.
- Tens of thousands of seniors currently enrolled in these plans will lose their in-network access to Mayo Clinic, forcing them to either switch insurance providers during the open enrollment period or pay much higher out-of-pocket costs to continue receiving care at Mayo.
- In Minnesota, the number of insurers offering Medicare Advantage plans with in-network access to Mayo Clinic will drop from five in 2025 to just two in 2026. This move is part of a larger trend that has seen Minnesota experience the second-largest drop in available Medicare Advantage plans in the nation..
Read Modern Healthcare's Article →
Johns Hopkins and UnitedHealthcare Officially End Negotiations, Leaving 60,000 Patients Out-of-Network
After eight months of negotiations and five extensions, Johns Hopkins Medicine and UnitedHealthcare have officially ended contract talks without a new agreement. As of August 25, Johns Hopkins facilities and providers are out-of-network for most UnitedHealthcare members, who were urged to find alternative insurance options during the open enrollment season.
- Approximately 60,000 people in Maryland, Washington, D.C., and Virginia are impacted by the dropped contract. These patients, including those with employer-sponsored, individual, Medicare Advantage, and Medicaid plans, now face paying significantly higher out-of-pocket costs or being forced to find new medical providers.
- The stalemate was reportedly not over money, as both sides had agreed on financial terms. The dispute centered on contract language related to patient care and denials.
- Johns Hopkins stated it would not agree to terms that allow an insurer to "prioritize profits over patients" by creating "excessive delays or denials" in care.
- UnitedHealthcare claimed Hopkins demanded "unacceptable" terms that would allow the health system to "refuse treatment for any member with an employer-based plan it does not want to do business with."
- Patients in active or ongoing treatment (like cancer or pregnancy) may apply for a "continuity of care" waiver, but this may only cover them at in-network rates for up to 90 days and must be approved by UnitedHealthcare.
LVHN to drop UnitedHealthcare insurance plans
Lehigh Valley Health Network (LVHN), part of Jefferson Health, has announced it will terminate its contracts with UnitedHealthcare in 2026 if a new agreement on payment rates is not reached.
- Lehigh Valley Health Network (LVHN), part of Jefferson Health, has announced it will terminate its contracts with UnitedHealthcare in 2026 if a new agreement on payment rates is not reached.
- The contract for patients with Medicare Advantage plans will end on January 25, 2026.
- The contract for patients with commercial insurance plans will end on April 25, 2026.
- LVHN claims it is terminating the contract because UnitedHealthcare has not paid negotiated rates since 2021, leading to a reimbursement that is 40% less than expected.
Thousands could lose affordable access to LCMC hospitals amid UnitedHealthCare contract dispute
LCMC Health and UnitedHealthcare are in a contract dispute, and if no agreement is reached by November 1, 2025, LCMC hospitals will become out-of-network for many UnitedHealthcare members.
- Thousands of patients who have UnitedHealthcare through their employer or the Affordable Care Act exchange will lose in-network access to eight major hospitals in the New Orleans metro area, forcing them to pay much higher out-of-network costs for hospital services.
- Patients Affected: LCMC states the dispute impacts 30,000 patients.
- Contract End Date: November 1, 2025.
- Hospitals Affected: 8 LCMC hospitals, including East Jefferson General Hospital, Manning Family Children's, New Orleans East Hospital, Touro Infirmary, University Medical Center, and West Jefferson Medical Center.
- The Dispute (LCMC's side): LCMC claims United wants to pay less than inflation and at a rate much lower than competitors, despite LCMC being the "lowest cost provider across the region."
Read the WWLTV Article →
UnitedHealth's Optum unit CFO has stepped down, Bloomberg News reports
Roger Connor has stepped down as the Chief Financial Officer of UnitedHealth's Optum unit after serving in the role for less than six months.
- Connor's departure is the latest in a significant "period of management reshuffling" at UnitedHealth, which has been appointing new leadership across its divisions after missing earnings targets earlier this year for the first time in over a decade.
- Connor is being replaced by Ben Eklo, a company veteran with 18 years of experience, who will take over the role on November 1.
- Connor, who is reportedly returning to the UK, will remain with the company through April to support the transition.
- This single departure is part of a larger executive shake-up at UnitedHealth.
- In the past year, the company has also appointed a new group CFO and a new CEO of Optum.
- New heads of Optum Rx (pharmacy) and Optum Health (clinics and home-care) have also been appointed during this period of reshuffling.
Read the Reuters Article →
Mayo Clinic to Leave Most UnitedHealthcare and Humana Medicare Advantage Networks
Effective January 1, 2026, Mayo Clinic will no longer be an in-network provider for most individual Medicare Advantage plans from UnitedHealthcare and Humana. This change will primarily affect patients at Mayo facilities in Minnesota, Wisconsin, and Iowa.
- Tens of thousands of seniors currently enrolled in these plans will lose their in-network access to Mayo Clinic, forcing them to either switch insurance providers during the open enrollment period or pay much higher out-of-pocket costs to continue receiving care at Mayo.
- In Minnesota, the number of insurers offering Medicare Advantage plans with in-network access to Mayo Clinic will drop from five in 2025 to just two in 2026. This move is part of a larger trend that has seen Minnesota experience the second-largest drop in available Medicare Advantage plans in the nation..
Johns Hopkins and UnitedHealthcare Officially End Negotiations, Leaving 60,000 Patients Out-of-Network
After eight months of negotiations and five extensions, Johns Hopkins Medicine and UnitedHealthcare have officially ended contract talks without a new agreement. As of August 25, Johns Hopkins facilities and providers are out-of-network for most UnitedHealthcare members, who were urged to find alternative insurance options during the open enrollment season.
- Approximately 60,000 people in Maryland, Washington, D.C., and Virginia are impacted by the dropped contract. These patients, including those with employer-sponsored, individual, Medicare Advantage, and Medicaid plans, now face paying significantly higher out-of-pocket costs or being forced to find new medical providers.
- The stalemate was reportedly not over money, as both sides had agreed on financial terms. The dispute centered on contract language related to patient care and denials.
- Johns Hopkins stated it would not agree to terms that allow an insurer to "prioritize profits over patients" by creating "excessive delays or denials" in care.
- UnitedHealthcare claimed Hopkins demanded "unacceptable" terms that would allow the health system to "refuse treatment for any member with an employer-based plan it does not want to do business with."
- Patients in active or ongoing treatment (like cancer or pregnancy) may apply for a "continuity of care" waiver, but this may only cover them at in-network rates for up to 90 days and must be approved by UnitedHealthcare.
LVHN to drop UnitedHealthcare insurance plans
Lehigh Valley Health Network (LVHN), part of Jefferson Health, has announced it will terminate its contracts with UnitedHealthcare in 2026 if a new agreement on payment rates is not reached.
- Lehigh Valley Health Network (LVHN), part of Jefferson Health, has announced it will terminate its contracts with UnitedHealthcare in 2026 if a new agreement on payment rates is not reached.
- The contract for patients with Medicare Advantage plans will end on January 25, 2026.
- The contract for patients with commercial insurance plans will end on April 25, 2026.
- LVHN claims it is terminating the contract because UnitedHealthcare has not paid negotiated rates since 2021, leading to a reimbursement that is 40% less than expected.
Thousands could lose affordable access to LCMC hospitals amid UnitedHealthCare contract dispute
LCMC Health and UnitedHealthcare are in a contract dispute, and if no agreement is reached by November 1, 2025, LCMC hospitals will become out-of-network for many UnitedHealthcare members.
- Thousands of patients who have UnitedHealthcare through their employer or the Affordable Care Act exchange will lose in-network access to eight major hospitals in the New Orleans metro area, forcing them to pay much higher out-of-network costs for hospital services.
- Patients Affected: LCMC states the dispute impacts 30,000 patients.
- Contract End Date: November 1, 2025.
- Hospitals Affected: 8 LCMC hospitals, including East Jefferson General Hospital, Manning Family Children's, New Orleans East Hospital, Touro Infirmary, University Medical Center, and West Jefferson Medical Center.
- The Dispute (LCMC's side): LCMC claims United wants to pay less than inflation and at a rate much lower than competitors, despite LCMC being the "lowest cost provider across the region."
UnitedHealth's Optum unit CFO has stepped down, Bloomberg News reports
Roger Connor has stepped down as the Chief Financial Officer of UnitedHealth's Optum unit after serving in the role for less than six months.
- Connor's departure is the latest in a significant "period of management reshuffling" at UnitedHealth, which has been appointing new leadership across its divisions after missing earnings targets earlier this year for the first time in over a decade.
- Connor is being replaced by Ben Eklo, a company veteran with 18 years of experience, who will take over the role on November 1.
- Connor, who is reportedly returning to the UK, will remain with the company through April to support the transition.
- This single departure is part of a larger executive shake-up at UnitedHealth.
- In the past year, the company has also appointed a new group CFO and a new CEO of Optum.
- New heads of Optum Rx (pharmacy) and Optum Health (clinics and home-care) have also been appointed during this period of reshuffling.
Drug Pricing & PBM Issues
UnitedHealth marked up lifesaving drugs as much as 1,000%: FTC
A class-action lawsuit filed in Minnesota accuses UnitedHealthcare, through its subsidiaries Optum Rx (its PBM) and Accredo (a specialty pharmacy), of significantly marking up the prices of specialty drugs, sometimes by thousands of dollars per prescription, compared to what the pharmacy actually paid for them. The lawsuit alleges this practice violates ERISA (Employee Retirement Income Security Act) because it breaches the fiduciary duty UnitedHealthcare owes to the employer-sponsored health plans it administers.
- The lawsuit provides examples where patients were allegedly charged exorbitant prices for critical medications. For instance, a multiple sclerosis drug (dimethyl fumarate) was allegedly marked up from the $200 Accredo paid to over $4,000 charged to the patient's plan. This practice allegedly forces patients and their health plans to pay vastly inflated prices for necessary, often life-saving, medications.
- Alleged markup on dimethyl fumarate: from ~$200 to over $4,000.
- Alleged markup on lenalidomide (cancer drug): from ~$300 to over $6,000.
- The lawsuit alleges UnitedHealthcare's PBM (Optum Rx) directs patients needing specialty drugs exclusively to its own affiliated specialty pharmacy (Accredo), creating a closed system ripe for inflated pricing.
- UnitedHealthcare is accused of hiding these markups from employers and patients through complex contracts and lack of transparency.
Read the NewsNationNow Article →
UnitedHealth Accused of Overcharging for Drugs in Class Action
A federal class-action lawsuit filed in Minnesota accuses UnitedHealth Group and its pharmacy benefit manager (PBM), Optum Rx, of breaching their fiduciary duties under ERISA by orchestrating a scheme to massively overcharge employer health plans for specialty medications dispensed through affiliated pharmacy Accredo. The suit alleges Optum Rx requires patients needing specialty drugs to use Accredo, which then charges the health plans vastly inflated prices compared to the actual cost of the drugs.
- The lawsuit claims Accredo marks up essential, often life-saving, specialty drugs by staggering amounts—allegedly charging health plans thousands of dollars more per prescription than the pharmacy paid. For example, the suit alleges Accredo charged over $4,000 for a multiple sclerosis drug it acquired for about $200, passing these inflated costs onto the health plans and ultimately the patients they cover.
- The lawsuit alleges violations of the Employee Retirement Income Security Act (ERISA).
- Example markup cited: Dimethyl fumarate (MS drug) allegedly acquired for ~$200 but billed to the plan at over $4,000.
- Example markup cited: Lenalidomide (cancer drug) allegedly acquired for ~$300 but billed to the plan at over $6,000.
- Accredo Specialty Pharmacy is owned by Cigna, but the lawsuit alleges it collaborates with UHG's Optum Rx in this pricing scheme.
Read the Courthouse News Article →
Knowing When and How to Fight Back: Protecting Independent Community Pharmacies From Overbearing Pharmacy Benefit Managers
Pharmacy Benefit Managers (PBMs), particularly the dominant few often integrated with large insurance companies or corporations (like CVS Caremark, Express Scripts/Cigna, Optum Rx/UnitedHealth), hold immense power over independent community pharmacies. They control network participation, reimbursement rates, drug formularies, and audit processes, often setting terms that make it difficult for independent pharmacies to compete or even survive financially.
- PBMs utilize various aggressive tactics that undermine independent pharmacies and potentially harm patient care. These include imposing below-cost reimbursement rates, charging retroactive Direct and Indirect Remuneration (DIR) fees long after prescriptions are filled, steering patients towards PBM-owned mail-order or specialty pharmacies, conducting burdensome audits, and creating complex, restrictive contracts and network requirements—all of which squeeze margins and threaten the viability of local pharmacies.
- The top 3 PBMs control approximately 80% of the prescription drug market.
- PBM tactics explicitly mentioned include: Spread Pricing (charging health plans more than they pay pharmacies), low reimbursements often below drug acquisition cost, retroactive DIR fees, patient steering, restrictive network contracts, burdensome audits, and complex credentialing/recredentialing processes.
- Independent pharmacies often face a "take it or leave it" scenario with PBM contracts due to the PBMs' market dominance.
- Legal and regulatory avenues for pharmacies include challenging PBM actions based on state PBM laws, reporting issues to state insurance departments or attorneys general, utilizing the ongoing FTC investigation into PBMs, and potential legal action (arbitration or litigation) for contract breaches or anticompetitive behavior.
Read the Buttaci Leardi & Werner Law Firm's informative Article →
Whistleblower Accounts & Patient Stories
Revealed: UnitedHealth Secretly Paid Nursing Homes to Reduce Hospital Transfers
A Guardian investigation based on thousands of confidential records and whistleblower interviews found that UnitedHealth Group secretly paid bonuses to nursing homes for reducing hospital transfers. The insurer embedded its own medical teams in approximately 2,000 nursing homes to push cost-cutting tactics and slash care expenses for residents on its Medicare Advantage plans.
- The investigation alleges that this bonus program directly harmed residents by delaying or denying necessary hospital care. In several cases, residents showing clear stroke symptoms were not transferred to a hospital after interventions from UnitedHealth staff, leading to permanent harm, including brain damage and paralysis, for some patients.
- The report is based on thousands of confidential corporate/patient records and interviews with more than 20 current and former UnitedHealth and nursing home employees.
- Whistleblowers alleged that staff were pressured to meet financial targets, such as a low "admissions per thousand" (APK) rate, which took priority over patient outcomes.
- Following the article's publication, UnitedHealth's shares dropped by more than 6%.
- UnitedHealth denied the allegations, called the report "verifiably false," stated the DOJ had already investigated and declined to pursue the matter, and subsequently filed a defamation lawsuit against The Guardian.
Read the Guardian's Article →
UnitedHealth Shares Fall Again, Following Reports on Kickbacks to Nursing Homes
UnitedHealth Group's shares tumbled after a Guardian report alleged the company paid secret bonuses to nursing homes. These payments were reportedly incentives for facilities to reduce costly hospital transfers for residents enrolled in UnitedHealthcare's Medicare Advantage plans.
- Whistleblowers allege the bonus program, which prioritized cost-cutting, led to the delay or denial of medically necessary hospital care for vulnerable seniors. In some cases, this resulted in permanent harm, including at least one resident who suffered brain damage after a delayed transfer for a stroke.
- Following the report, UnitedHealth's shares fell by as much as 8%, closing down 5.78% at $302.98.
- The program was reportedly implemented in approximately 2,000 nursing homes where UnitedHealth's own medical teams were stationed.
- HSBC analysts downgraded UHG's stock from "Hold" to "Reduce" and cut its price target to a "street-low" of $270.
- UnitedHealth filed a defamation lawsuit against The Guardian in response, calling the report "blatantly false and misleading" and stating that the Department of Justice had already investigated the allegations and "declined to pursue the matter."
Read the Fierce Healthcare Article →
UnitedHealth Faces Federal Scrutiny Into Whistleblower Claims
In the wake of The Guardian's reporting, U.S. lawmakers from both parties are now "raising concerns and seeking investigations" into UnitedHealth's nursing home programs. Senator Ron Wyden has launched a "full investigation," and Representatives Alexandria Ocasio-Cortez and Lloyd Doggett are urging the Department of Justice to "thoroughly review new revelations" of "potential waste, fraud, and abuse at UnitedHealth."
- The article details sworn declarations from whistleblowers, including one who alleged UnitedHealth "actively avoided medically necessary hospitalizations... in serious life-threatening situations" to cut costs. The declaration further claims the company "drove vulnerable patients toward signing Do Not Resuscitate (DNRs) and Do Not Hospitalize orders to avoid providing hospital services for life threatening illnesses."
- A third whistleblower, whose lawsuit is still pending, alleges UHC "paid kickbacks to nursing homes" to get illegal referrals and used "improper marketing tactics" to enroll vulnerable residents, sometimes violating federal medical privacy (HIPAA) laws.
- Despite UnitedHealth filing a defamation lawsuit, The Guardian stated it "stands by its 'deeply sourced, independent reporting'" which is based on "thousands" of records and interviews with "more than 20" current and former employees.
- UnitedHealth denies the allegations, stating the DOJ has already "declined to pursue the matter" (referring to a previous decision not to intervene in the whistleblower lawsuits).
Read the Guardian's Second Article →
UnitedHealth Group Resists Shareholder Proposal on Delayed and Denied Care
UnitedHealth Group (UHG) asked the Securities and Exchange Commission (SEC) to block a non-binding shareholder proposal that would require the company to report on the broader economic and public health costs associated with its practices that delay or deny patient care. The proposal was filed by members of the Interfaith Center on Corporate Responsibility (ICCR), representing institutional investors like pensions and foundations.
- The shareholders argue that UHG, being the largest US health insurer and the 19th-largest company globally, has such significant market power that its care denial practices (like prior authorizations) could harm the overall US economy by keeping workers sick, indebted, and less productive, ultimately hurting the investors' diverse portfolios.
- UHG is the 19th-largest company in the world by market capitalization.
- More than 5% of the US gross domestic product flows through UHG each day.
- The shareholder proposal cited a 2023 KFF survey finding 18% of insured US adults reported having a claim denied in the past year.
- UnitedHealth argued the proposal should be excluded partly because terms like "public health-related costs" and "macroeconomic risks" are too vague. Update: The shareholders later withdrew the proposal after UHG challenged it twice following changes in SEC guidance, but plan to continue dialogue with the company.
Read the Guardian's Article →
UnitedHealth under scrutiny for nursing home practices
UnitedHealth Group is facing scrutiny over accusations that it provided financial bonuses to nursing homes to incentivize them to reduce the number of patients transferred to hospitals, a practice allegedly designed to cut costs.
- Families and whistleblowers allege that this practice of incentivizing fewer hospital visits has led to residents' medical issues being concealed, delayed, or denied, halting necessary treatment and placing their health at risk for the sake of profit.
- The allegations are part of a broader scrutiny into UnitedHealth's cost-cutting tactics within its Medicare Advantage plans.
- Whistleblower declarations from nurse practitioners who worked for UnitedHealth allege the company's bonus system led to "delays and denials of medically necessary care."
- Federal lawmakers, including Sens. Ron Wyden and Elizabeth Warren, have launched investigations into the practice, questioning its effect on patient safety.
- UnitedHealth has faced a defamation lawsuit against The Guardian for its original reporting on the matter, which the company called "blatantly false and misleading."
Vincent Cinque, an advocate for his family members speaks out about his family's story
- Vincent Cinque is a family advocate whose mother and grandmother are both in nursing homes.
- Vincent's families experiences are in line with the alleged practices the senate is investigating UHG for including up-coding and minimizing hospital transfers.
- Cinque is fighting to get answers and ensure they receive the proper care, stating that their necessary treatment has been "halted for some time."
- "It Feels like the system is designed to break us, to crack us, and to make us give up. But I don't want to give up on my Mom."
-Vincent Cinque
The Human Cost & Public Reaction
UnitedHealth Group is Too Big. Here's How That Puts Your Care at Risk.
The article argues that UnitedHealth Group's (UHG) massive size and vertical integration—owning insurance plans (UnitedHealthcare), PBMs (Optum Rx), physician groups (Optum Care), and technology platforms (Optum Insight, Change Healthcare)—create significant conflicts of interest. This consolidation allows UHG to prioritize its own profits over patient care, leading to issues like restrictive networks, denials of care, and inflated costs across the healthcare system.
- UHG's control over various parts of the healthcare system enables it to engage in practices that harm patients and competitors. Examples cited include using its PBM to favor its own pharmacies, employing potentially flawed AI (like nH Predict) to deny necessary post-acute care for Medicare Advantage patients, and leveraging its market power to squeeze out independent providers, ultimately reducing patient choice and potentially compromising care quality.
- UHG is the largest health insurer in the U.S. and the largest employer of physicians (Optum employs or is affiliated with ~90,000 doctors).
- Its PBM, Optum Rx, is one of the three largest, controlling a significant portion of the prescription drug market alongside CVS Caremark and Express Scripts.
- The company's immense size means its operations influence a substantial portion of the U.S. healthcare economy, raising concerns about market concentration and its negative effects on competition and costs.
Read the MSNBC Op-ed Article →
Investors Call on UnitedHealth Group to Report on Public Health Costs of Care Denials
A coalition of shareholders, the Interfaith Center on Corporate Responsibility (ICCR), filed a formal proposal requesting that UnitedHealth Group's Board of Directors prepare a report on the public health-related costs and macroeconomic risks created by its own practices that limit or delay patient care.
- This shareholder proposal was filed just one month after the fatal shooting of UnitedHealthcare CEO Brian Thompson. Proponents of the proposal explicitly linked the request to this event, stating that the "public outrage over the exorbitant costs and restricted access to healthcare has reached a dangerous level".
- The proposal was filed by the Interfaith Center on Corporate Responsibility (ICCR), which represents over 300 institutional investor groups.
- It specifically asks the company to evaluate how often its prior authorization requirements and coverage denials lead to patients delaying or abandoning medical treatment, and how often they result in "serious adverse events".
- The investors argue that while denial practices may boost short-term revenue, they create long-term "reputational and legal risks" for UnitedHealth and also harm the broader economy by reducing worker productivity and consumer spending power.
- The proposal comes amid intense media and legislative scrutiny over UnitedHealth's market dominance and its alleged use of AI algorithms to deny care to Medicare Advantage patients.
Read the StatNews Article →
Trump DOJ Gives Monopolist UnitedHealth a Green Light to Swallow Yet Another Competitor
The Trump administration's Department of Justice (DOJ) settled a Biden-era antitrust lawsuit that was originally filed to block UnitedHealth Group's $3.3 billion acquisition of the home health and hospice provider Amedisys.
- Critics, including Senator Elizabeth Warren and the American Economic Liberties Project, called the settlement "half-baked". They allege it allows UnitedHealth to divest the required locations to "similarly conflicted buyers," including a private equity firm, rather than truly restoring competition, and suggested the deal may be based on "political favors".
- The original lawsuit was filed in November 2024 by the Biden DOJ and the attorneys general of several states.
- The Biden-era DOJ warned the merger would let UnitedHealth "further extend its grip" on home health care, "threatening seniors, their families, and nurses".
- The settlement requires UnitedHealth to divest 164 home health and hospice locations across 19 states.
- A recent analysis cited in the article states that UnitedHealth Group currently has around 2,700 subsidiaries.
Read the Common Dreams Article →
Opinion: A grim reminder of the health insurance industry’s human cost
The article, written by former health insurance executive Wendell Potter, argues that the "reprehensible murder" of UnitedHealthcare's CEO Brian Thompson has exposed the deep, simmering anger and frustration that millions of Americans feel toward a healthcare system they experience as being rigged against them.
- Potter, a whistleblower from Cigna, states this anger is predictable because the industry's business model is designed to deny necessary care for profit. He says it's not hyperbole to state that these companies "have acted with violence" toward patients through delays and denials that shorten lives and cause immense suffering.
- Potter notes that this public rage has been building for years as companies "as a matter of business, denied necessary care for years and years".
- He states that even when patients appeal a denial, which few do, the majority of those appeals are approved, showing that the initial denials for "medically necessary care" were wrong.
- Potter claims the insurance industry spends an "enormous amount of money" to keep this "extraordinarily profitable" system in place, prioritizing shareholders over patients.
UnitedHealth Is Sick of Everyone Complaining About Its Claim Denials
In the wake of CEO Brian Thompson's murder and the subsequent public backlash over claim denials, UnitedHealth Group has become more proactive in "confronting negative stories," including sending a letter from a defamation law firm to a doctor who spoke out against the company.
- Shareholders filed proposals seeking an audit of the company's denial rates, with one proposal suggesting that if an independent auditor finds a claim was wrongly denied, the company should "send a formal apology to those families". UnitedHealth argued against these proposals in letters to the SEC, calling them "impermissibly micromanaging" and "too vague".
- Public support for Mangione on social media, where he was called a "hero" by some, disturbed UnitedHealthcare and was a factor in the company's defensive PR strategy.
- Critics allege the company's defensive approach, like blocking shareholder proposals and sending "stern letters to doctors," suggests it is "more anxious than ever to shut down anything that might inspire the next Mangione".
- This article speaks volumes that something must be done to stop the Denial Echo Chamber that Health Insurance Companies have corrupted the appeals process into for the sake of corporate profits, fed by the lives and limbs of the patient victims.
Read the RollingStone Article →
Investors Are Pressing UnitedHealth Group to Deny More Care
Investors are suing UnitedHealth Group, not for its high denial rates, but because they are concerned the company's "corporate practices" have become "too consumer-friendly" in the face of public pressure, leading to a drop in stock value.
- The investor lawsuit explicitly admits that the company's previously "sky-high" denial rates "reaped them enormous profits," and they are now suing to stop the insurer from approving more patient care, which they see as a threat to their earnings.
- The investor lawsuit was filed after UnitedHealth's "disastrous" first quarter of 2025, which saw "cratering stock value".
- UnitedHealth Group has one of the highest denial rates of any major insurer and was one of the first to be criticized for using AI to deny care.
- A recent study (prior to the article) asserted that UnitedHealthcare denies about one in every three claims.
- The company's profits have skyrocketed, with UnitedHealth Group accounting for over 40% of the $371 billion in profits made by the top five health insurers since the Affordable Care Act passed.
A Personal Account: "My UHC denial experience"
UnitedHealthcare (UHC) attempted to deny coverage for a 4-week-long hospital stay following a severe car accident where the patient broke both hips, a foot, an ankle, and both wrists.
- UHC's "expert doctors" reviewed the case and determined that after just 24 hours, the patient—who was temporarily paralyzed from the waist down and couldn't move—no longer "needed to be there".
- The patient was left with a $40,000 bill after their auto insurance paid its portion.
- After months of fighting, UHC eventually "just stopped pursuing" the bill.
- Commenters on the post noted that UHC has the highest denial rate by far, with one user stating it is "over 30%" or "32%".
- Another user, a self-identified state insurance regulator, stated that regulators are "completely impotent" and "useless" against these company practices.
Read the personal account on Reddit →
Killing of UnitedHealthcare CEO prompts flurry of stories on social media over denied insurance claims
The fatal shooting of UnitedHealthcare CEO Brian Thompson, and the discovery of shell casings with the words "deny," "defend," and "depose", unleashed a massive outpouring of public anger and frustration online, with many people sharing personal horror stories about their insurance claims being denied.
- A 2021 KFF analysis (cited in reports covering the CNN story) showed that UnitedHealth's qualified health plans in Arizona denied almost 39% of in-network claims. This was more than double the average denial rate of 17% for comparable plans nationwide that year.
- A U.S. Senate subcommittee report found UnitedHealthcare's prior authorization denial rate for post-acute care doubled from 10.9% in 2020 to 22.7% in 2022.
- A 2023 KFF survey found that nearly 1 in 5 (18%) insured adults reported having a claim denied in the past 12 months.
- A new poll found that about 7 in 10 U.S. adults believe that "denials for health care coverage" and "profits made by health insurance companies" bear at least a "moderate amount" of responsibility for Thompson's death.
- Americans under 30 were especially likely to attribute blame, with about 7 in 10 saying that insurance denials and profits are about as responsible as the killer for his death.
Read the CNN Article →
United Healthcare WHISTLEBLOWER Reveals Fraud, Forced Claim Denials
A former UnitedHealthcare (UHC) medical claims employee alleges she was "taught so many different ways to deny" claims]. She describes a specific case where the company was fighting "tooth and nail" to deny a hospice claim for a man who had died of pancreatic cancer, leaving his widow with five children to face court action and wage garnishment, [05:33], [05:46].
- The whistleblower alleges a fraudulent practice where she was "approved a certain amount of monies" per day]. This daily budget—not the medical merits of the claims—dictated what she could pay, meaning if one large claim was paid, no other claims could be, regardless of their validity. She describes this as "Health rationing" and "fraud", [08:22]
- The whistleblower claims supervisors would stand behind employees and laugh while the employees were crying on the phone with members, [02:31].
- She alleges that in the case of the widow, UHC was trying to force the single mother to pay a bill of around $400,000 or $500,000.
- The video also references a separate poll from NOC at the University of Chicago, which found that about 8 in 10 US adults said the killer of the UHC CEO has responsibility, but 7 in 10 adults also say that "denials for health care coverage" and "profits" bear at least a "moderate amount of responsibility" for the death, [01:14:18], [01:14:25].
Watch the WHISTLEBLOWER Coverage of United Health Care's Eugenics Denial Echo Chamber Buisness Practices →
Whistleblower Exposes Health Insurers' Most Evil Scheme
A whistleblower, "Max," who worked for a third-party company that handles prior authorizations, states the infamous "deny, delay, and defend" strategy is an "unspoken understanding", [07:15]]. He reveals that management would never explicitly say "let's deny more requests," but would instead say, "let's send more requests to review," knowing this would achieve the same outcome, as many patients would simply give up on the process.
- The video details the case of Kathleen Valentini, whose doctor ordered an MRI for hip pain. The prior authorization was denied, and the 5-week delay to appeal the decision allowed her fast-growing cancer (sarcoma) to spread, [01:51], [01:59]]. As a result of the delay, she was forced to have her entire leg amputated and was eventually killed by the aggressive cancer, [09:59].
- An American Medical Association survey found that 80% of doctors report patients have "abandoned their treatment" because of the prior authorization process.
- The same survey found 19% of doctors say prior authorizations have led to "life-threatening events" or required intervention to "prevent permanent impairment or damage".
- A family doctor describes a prior authorization denial for a wheelchair for her patient who just had both of his legs amputated]. The denial reason was that she "didn't specify how his walking would be affected by his disability".
Watch More Perfect Union's YouTube Coverage →
The $1 Trillion Private Health Insurance Scam
The video argues that the privatized Medicare Advantage (Part C) program costs taxpayers significantly more and provides worse care than the traditional, public Medicare (Parts A and B) [07:04].
- Medicare Advantage plans systematically deny necessary medical care that traditional Medicare would have otherwise approved and covered. The video highlights a study where nearly 15% of 5.6 million care denials were attributed to Medicare Advantage's more restrictive policies [07:52], a situation the narrator personally experienced when his mother was denied rehab facility care in her final days [00:11].
- Traditional public Medicare spends 98.6% of its budget on patient care, with only 1.4% going to administrative costs [01:51].
- For-profit Medicare Advantage plans, by contrast, spend only 85% on care, with 15% going to administrative costs, executive salaries, and profits—10 times higher than the public option [09:04].
- Medicare Advantage plans cost taxpayers an estimated $300 to $1,000 more per patient than traditional Medicare [07:13].
- Americans are expected to pay nearly $1 trillion in taxpayer money just for overpayments to these private insurance programs in the coming years [07:28].
Watch More Perfect Union's YouTube Coverage →
Hear Two UnitedHealthcare Representatives Discuss Someone’s Health Insurance Case
A ProPublica investigation details the story of Chris McNaughton, a college student with ulcerative colitis, who sued UnitedHealthcare after the insurer denied coverage for his essential, life-saving medication by claiming it was "not medically necessary," despite it being the only treatment that worked after all others had failed [00:21].
- Through the lawsuit, the patient obtained an internal phone call where two UnitedHealthcare employees were recorded laughing about the denial of his claim [00:09].
- The patient's medical bills were nearly $2 million a year when UnitedHealthcare flagged his account and denied payment [00:45].
- A UnitedHealthcare doctor admitted under oath to signing over 10,000 denials for the company, stating he often didn't look at the medical records and would "cut and paste" denial language from a nurse's notes [01:01].
- The lawsuit revealed that when UnitedHealthcare paid for a doctor's opinion that agreed with the patient, the company ignored and buried that report [01:21].
Watch ProPublica's Coverage on YouTube →
Read ProPublica's Coverage on YouTube →
Read Kare 11's News Coverage →
Read Uscher, Quiat, Uscher & Russo's Blog about United Healthcare's shamfeul and cruel tactics →
Letter to UnitedHealthcare on Retroactive Denial of Coverage for Emergency-Level Care
In a June 2021 letter, the American Hospital Association (AHA) strongly urged UnitedHealthcare (UHC) to "immediately reverse" its new policy that allows the insurer to retroactively deny coverage for emergency room visits it deems non-emergent after the fact.
- The AHA warned that this policy is "dangerous for patients' health" because it threatens them with a financial penalty for seeking care. This could have a "chilling effect," causing patients to second-guess themselves and avoid the emergency room during what they believe is a medical emergency, which is "particularly unsafe" given that deferred care has already led to adverse health conditions.
- The AHA points out this financially-motivated policy comes as UHC's parent company, UnitedHealth Group, posted a 35% year-over-year jump in operating profits in the first quarter of 2021.
- In that same quarter, UnitedHealth Group earned $6.7 billion in profit.
Read the American Hospital Association published Letter to Brian Thompson from 2021. →
United Healthcare Insurance a Scam Allowed to Happen
Data indicates that UnitedHealthcare denies about one-third of all submitted claims, a rate that is double the industry average.
- A 2023 class-action lawsuit alleges that UnitedHealthcare's AI algorithm, known as "nH Predict," has a 90% error rate and has been used to unjustly deny coverage, particularly for elderly patients requiring post-acute care.
- UnitedHealthcare denies approximately one-third (33%) of all claims submitted.
- UHC's claim denial rate is double the industry average.
- The "nH Predict" AI model allegedly has a 90% error rate.
- UnitedHealth Group, the parent company, reported a gross profit of approximately $90.1 billion for the twelve months ending September 30, 2024.
Read the USAttorneys.com Article →
UHC, Denials, and Wrongful Death Revisited
The article is a philosophical exploration of whether a health insurance denial can be morally equivalent to a "wrongful death." The author argues that to justify the killing of CEO Brian Thompson, one would have to prove he was personally and systematically responsible for wrongful killings through specific types of denials (like prior authorization denials for life-saving care), a connection the author finds plausible but ultimately unproven.
- The author, who works in hospital denials management, states that even at a low level, "the bad faith and deception" of insurance companies are "totally transparent" and describes a common scenario where an insurer denies a clearly covered, necessary, and expensive procedure as "not medically necessary," which they know is false.
- The author distinguishes between "claim denials" (denying reimbursement after treatment is given) and "prior authorization denials" (denying treatment before it is given).
- The author argues that only prior authorization denials for life-saving procedures could plausibly be considered "wrongful killing," whereas claim denials (which happen after the patient is cured) cannot.
- The author notes that UHC's overall denial rate is high, but its prior authorization rate is "relatively low" compared to other insurers like Humana, which "might suggest prima facie that Humana's CEO would have been a better target."
- The author posits that "lack of insurance is a bigger driver of mortality (if anything is) than wrongful-death denials among the insured."
Read the philosophy →
INHUMANE: UnitedHealth Group REJECTS 1 out of 3 Medical Claims
The video details UnitedHealth Group's "vertical integration" strategy, a business model designed to get "a cut of every single step of the healthcare process." This includes owning the insurer (UnitedHealthcare), the pharmacy (Optum Rx), and the doctors themselves, with its subsidiary Optum being the largest employer of physicians in the United States [06:04].
- UnitedHealthcare's high rate of claim denials is presented as a deliberate strategy to starve doctor's offices of cash, forcing them to take out predatory "payday loans" to stay afloat. United's own subsidiary, Optum, offers one of these loan services, directly profiting from the financial distress it creates for medical providers [05:33].
- The video highlights that UnitedHealthcare denies nearly 1 in 3 (32%) of all medical claims [03:45].
- The general industry average for claim denials is nearly 1 in 5 [03:34].
- UnitedHealthcare is the largest employer of physicians in America, with 70,000 doctors on its payroll [06:04].
- One report found that 41% of healthcare providers had to take out external loans to stay financially afloat, a problem exacerbated by insurer's denial practices [05:07].
Watch Revolutionary Change's YouTube Coverage →
Bipartisan Support for Policies that Protect People from Medical Debt
There is overwhelming bipartisan support among voters for new legal protections against medical debt, with large majorities favoring government action to shield patients from unaffordable costs.
- A significant portion of voters (35%) reported currently owing money or having debts due to medical or dental expenses, indicating that even having health insurance often fails to protect people from burdensome medical debt.
- 84% of voters believe having health insurance should protect people from medical debt.
- 74% believe the current health insurance system is "mostly failing" at protecting people from medical debt.
- The majority of voters blame the insurance industry primarily for medical debt issues, rather than hospitals or drug makers.
- There is strong bipartisan support for specific policies, such as removing medical debt from credit reports and setting limits on hospital charges.
- The poll surveyed 1,319 general election voters between August 21 and September 2, 2025.
Read the Survey Results →
External Health Insurance Watchlists & Resources
UnitedHealth Group Abuse Tracker →
Maintained by: American Economic Liberties Project (AELP)
This resource compiles news reports, legal filings, and analyses concerning alleged anticompetitive practices, patient care issues, and market power abuses involving UnitedHealth Group and its various subsidiaries across the healthcare industry.
HEALTHCARE - People Over Profit
The page details multiple "Deaths by Denial," providing specific examples of patients (Little John Cupp, Nataline Sarkisyan, Tracy Pike) who died after insurance companies like United Health Care, CIGNA, and Blue Cross Blue Shield repeatedly denied their doctors' requests for life-saving or necessary medical treatments, often deeming them "not medically necessary."
- A 2023 class-action lawsuit alleges United Health Group uses an AI algorithm, "nH Predict," to illegally deny care to elderly patients, despite the algorithm having a 90% error rate. The lawsuit claims UHC knows the algorithm is flawed but uses it anyway, aware that only a small percentage of patients will appeal.
- UnitedHealth has a 32% claims denial rate, which is twice the industry average and represents nearly one in three claims being denied.
- The "nH Predict" AI algorithm allegedly has a 90% error rate, based on the percentage of payment denials that are reversed through the internal appeals process.
- One "medical benefits management company" (EviCore) that insurers hire to deny claims advertises to them a 3-to-1 return on investment.
- A 2022 survey of oncologists found that 42% of prior authorizations were delayed, with doctors attributing "loss of life" to these delays 36% of the time.
Read the POPNYC.org Article →
The Rise of the Healthcare Influencers
30 Days of US Healthcare:Day 26: United Healthcare Denies Everything
The video is a satirical sketch that portrays a private health insurance employee denying a wide range of necessary medical treatments and medications for absurd and bureaucratic reasons, highlighting the frustrations patients and doctors face [00:00].
- The sketch illustrates insurance representatives denying life-sustaining care, including telling a patient they must wait 6-8 weeks for an appeal for insulin [01:06] and refusing to approve a new battery for a pacemaker, suggesting "maybe the heart's figured it out by now" [01:45].
- Denial of a CT scan for cancer surveillance [00:32].
- Denial of a brain tumor scan, with the suggestion it might "go away on its own" [00:39].
- Denial of rehab facility care because the employee "didn't get the vibe" that the patient would rehab well [00:48].
- Requiring a patient to prove they still have Type 1 diabetes to get their insulin prescription refilled [02:01].
- Requiring a patient to "fail" two other ADHD medications before approving the one they have been stable on for a year [02:12].
Watch Dr. Glaucomflecken on YouTube →
30 Days of US Healthcare:Day 12: Automated Claim Denials
The video is a satirical sketch depicting an insurance company that uses an "automated system" to flag claims, which are then "reviewed" by medical directors who deny them all without looking at any clinical documentation [00:25], [00:45].
- The company's goal is to save money by "blanket denying everything," because the appeal process is intentionally made so confusing that only 5% of all denied claims are ever appealed, forcing customers to pay out of pocket or "go bankrupt" [01:12].
- The fictional company denied over 300,000 claims in two months [00:00].
- The "medical directors" can deny a claim in 1.2 seconds [00:59].
- Only 5% of denied claims are appealed due to the confusing process [01:19].
- The company boasts that its doctors "click so fast" they need treatment for index finger arthritis, which is "not covered by insurance" [01:06].
Watch Dr. Glaucomflecken on YouTube →
30 Days of US Healthcare:Day 5: Prior Authorizations
The video is a satirical sketch that portrays the invention of "prior authorization" as a deliberate strategy by an insurance company to "wedge ourselves into industries we know nothing about" and force doctors to ask for permission before providing "anything" to a patient [00:29], [00:41].
- The characters in the sketch openly acknowledge that by denying authorizations, they are "practicing medicine without a license" [01:10]. They also admit their denials either prevent patients from getting needed treatment or leave them "financially devastated" if they get the care anyway [00:56].
- The policy was created to challenge doctors who believe their "decade of medical training" gives them the right to order necessary tests or treatments for their patients [00:16].
- The characters admit the policy is not for rare, expensive treatments but is a tool to "generate wealth by needlessly delaying routine medical care" [01:24].
- The practice is justified with the logic: "it's legal and it makes us money, therefore it's good" [01:10].
Watch Dr. Glaucomflecken on YouTube →
Dr. Exposes UnitedHealthcare in ONE Call!
The video features a "peer-to-peer" call where a plastic surgeon, Dr. Elizabeth Potter, records a UnitedHealthcare (UHC) doctor attempting to deny a preventative lymphedema surgery for her breast cancer patient. Dr. Potter exposes the UHC doctor as unqualified to make the decision, as he is not a "peer" in this specialty, has never performed the procedure, and does not treat lymphedema or breast cancer patients [00:04], [02:32], [03:03].
- The UnitedHealthcare doctor on the call, who is an "ocular plastic surgeon" (eyelid surgeon) and unfamiliar with lymphedema of the arm, refuses to provide his name to Dr. Potter, claiming it is for his own protection [00:00], [00:50], [01:03].
- Dr. Potter states her patient has a 40% risk of developing lymphedema following her required cancer treatment [04:14].
- The requested preventative surgery, lymphovenous bypass, would reduce the patient's risk of lymphedema from 40% down to 10% [04:14].
- The video alleges that UnitedHealth has lost over 50% of its profit since its CEO's death and is under investigation by the Department of Justice for alleged fraud in its Medicare program [05:43].
- UnitedHealthcare sent Dr. Potter a letter demanding she take the video down and publicly apologize, which she refused to do [05:05].
Watch the YouTube Coverage →
United Healthcare Denials
According to data from ValuePenguin, United Healthcare denies 32% of all claims, a rate that is "significantly higher than industry averages" and almost 50% higher than the industry standard.
- The article states that for surgeons providing elective care, the denial rate from United Healthcare can "soar to 80%."
- United Healthcare denies 32% of all claims.
- The denial rate for elective surgery can be as high as 80%.
- Nearly half of all denied claims stem from the prior authorization process.
- The article lists "AI-Driven Claim Denials" as a systemic strategy insurers use, where autonomous systems reject claims "without proper contextual understanding."
UnitedHealth marked up lifesaving drugs as much as 1,000%: FTC
A class-action lawsuit filed in Minnesota accuses UnitedHealthcare, through its subsidiaries Optum Rx (its PBM) and Accredo (a specialty pharmacy), of significantly marking up the prices of specialty drugs, sometimes by thousands of dollars per prescription, compared to what the pharmacy actually paid for them. The lawsuit alleges this practice violates ERISA (Employee Retirement Income Security Act) because it breaches the fiduciary duty UnitedHealthcare owes to the employer-sponsored health plans it administers.
- The lawsuit provides examples where patients were allegedly charged exorbitant prices for critical medications. For instance, a multiple sclerosis drug (dimethyl fumarate) was allegedly marked up from the $200 Accredo paid to over $4,000 charged to the patient's plan. This practice allegedly forces patients and their health plans to pay vastly inflated prices for necessary, often life-saving, medications.
- Alleged markup on dimethyl fumarate: from ~$200 to over $4,000.
- Alleged markup on lenalidomide (cancer drug): from ~$300 to over $6,000.
- The lawsuit alleges UnitedHealthcare's PBM (Optum Rx) directs patients needing specialty drugs exclusively to its own affiliated specialty pharmacy (Accredo), creating a closed system ripe for inflated pricing.
- UnitedHealthcare is accused of hiding these markups from employers and patients through complex contracts and lack of transparency.
UnitedHealth Accused of Overcharging for Drugs in Class Action
A federal class-action lawsuit filed in Minnesota accuses UnitedHealth Group and its pharmacy benefit manager (PBM), Optum Rx, of breaching their fiduciary duties under ERISA by orchestrating a scheme to massively overcharge employer health plans for specialty medications dispensed through affiliated pharmacy Accredo. The suit alleges Optum Rx requires patients needing specialty drugs to use Accredo, which then charges the health plans vastly inflated prices compared to the actual cost of the drugs.
- The lawsuit claims Accredo marks up essential, often life-saving, specialty drugs by staggering amounts—allegedly charging health plans thousands of dollars more per prescription than the pharmacy paid. For example, the suit alleges Accredo charged over $4,000 for a multiple sclerosis drug it acquired for about $200, passing these inflated costs onto the health plans and ultimately the patients they cover.
- The lawsuit alleges violations of the Employee Retirement Income Security Act (ERISA).
- Example markup cited: Dimethyl fumarate (MS drug) allegedly acquired for ~$200 but billed to the plan at over $4,000.
- Example markup cited: Lenalidomide (cancer drug) allegedly acquired for ~$300 but billed to the plan at over $6,000.
- Accredo Specialty Pharmacy is owned by Cigna, but the lawsuit alleges it collaborates with UHG's Optum Rx in this pricing scheme.
Knowing When and How to Fight Back: Protecting Independent Community Pharmacies From Overbearing Pharmacy Benefit Managers
Pharmacy Benefit Managers (PBMs), particularly the dominant few often integrated with large insurance companies or corporations (like CVS Caremark, Express Scripts/Cigna, Optum Rx/UnitedHealth), hold immense power over independent community pharmacies. They control network participation, reimbursement rates, drug formularies, and audit processes, often setting terms that make it difficult for independent pharmacies to compete or even survive financially.
- PBMs utilize various aggressive tactics that undermine independent pharmacies and potentially harm patient care. These include imposing below-cost reimbursement rates, charging retroactive Direct and Indirect Remuneration (DIR) fees long after prescriptions are filled, steering patients towards PBM-owned mail-order or specialty pharmacies, conducting burdensome audits, and creating complex, restrictive contracts and network requirements—all of which squeeze margins and threaten the viability of local pharmacies.
- The top 3 PBMs control approximately 80% of the prescription drug market.
- PBM tactics explicitly mentioned include: Spread Pricing (charging health plans more than they pay pharmacies), low reimbursements often below drug acquisition cost, retroactive DIR fees, patient steering, restrictive network contracts, burdensome audits, and complex credentialing/recredentialing processes.
- Independent pharmacies often face a "take it or leave it" scenario with PBM contracts due to the PBMs' market dominance.
- Legal and regulatory avenues for pharmacies include challenging PBM actions based on state PBM laws, reporting issues to state insurance departments or attorneys general, utilizing the ongoing FTC investigation into PBMs, and potential legal action (arbitration or litigation) for contract breaches or anticompetitive behavior.
Whistleblower Accounts & Patient Stories
Revealed: UnitedHealth Secretly Paid Nursing Homes to Reduce Hospital Transfers
A Guardian investigation based on thousands of confidential records and whistleblower interviews found that UnitedHealth Group secretly paid bonuses to nursing homes for reducing hospital transfers. The insurer embedded its own medical teams in approximately 2,000 nursing homes to push cost-cutting tactics and slash care expenses for residents on its Medicare Advantage plans.
- The investigation alleges that this bonus program directly harmed residents by delaying or denying necessary hospital care. In several cases, residents showing clear stroke symptoms were not transferred to a hospital after interventions from UnitedHealth staff, leading to permanent harm, including brain damage and paralysis, for some patients.
- The report is based on thousands of confidential corporate/patient records and interviews with more than 20 current and former UnitedHealth and nursing home employees.
- Whistleblowers alleged that staff were pressured to meet financial targets, such as a low "admissions per thousand" (APK) rate, which took priority over patient outcomes.
- Following the article's publication, UnitedHealth's shares dropped by more than 6%.
- UnitedHealth denied the allegations, called the report "verifiably false," stated the DOJ had already investigated and declined to pursue the matter, and subsequently filed a defamation lawsuit against The Guardian.
UnitedHealth Shares Fall Again, Following Reports on Kickbacks to Nursing Homes
UnitedHealth Group's shares tumbled after a Guardian report alleged the company paid secret bonuses to nursing homes. These payments were reportedly incentives for facilities to reduce costly hospital transfers for residents enrolled in UnitedHealthcare's Medicare Advantage plans.
- Whistleblowers allege the bonus program, which prioritized cost-cutting, led to the delay or denial of medically necessary hospital care for vulnerable seniors. In some cases, this resulted in permanent harm, including at least one resident who suffered brain damage after a delayed transfer for a stroke.
- Following the report, UnitedHealth's shares fell by as much as 8%, closing down 5.78% at $302.98.
- The program was reportedly implemented in approximately 2,000 nursing homes where UnitedHealth's own medical teams were stationed.
- HSBC analysts downgraded UHG's stock from "Hold" to "Reduce" and cut its price target to a "street-low" of $270.
- UnitedHealth filed a defamation lawsuit against The Guardian in response, calling the report "blatantly false and misleading" and stating that the Department of Justice had already investigated the allegations and "declined to pursue the matter."
UnitedHealth Faces Federal Scrutiny Into Whistleblower Claims
In the wake of The Guardian's reporting, U.S. lawmakers from both parties are now "raising concerns and seeking investigations" into UnitedHealth's nursing home programs. Senator Ron Wyden has launched a "full investigation," and Representatives Alexandria Ocasio-Cortez and Lloyd Doggett are urging the Department of Justice to "thoroughly review new revelations" of "potential waste, fraud, and abuse at UnitedHealth."
- The article details sworn declarations from whistleblowers, including one who alleged UnitedHealth "actively avoided medically necessary hospitalizations... in serious life-threatening situations" to cut costs. The declaration further claims the company "drove vulnerable patients toward signing Do Not Resuscitate (DNRs) and Do Not Hospitalize orders to avoid providing hospital services for life threatening illnesses."
- A third whistleblower, whose lawsuit is still pending, alleges UHC "paid kickbacks to nursing homes" to get illegal referrals and used "improper marketing tactics" to enroll vulnerable residents, sometimes violating federal medical privacy (HIPAA) laws.
- Despite UnitedHealth filing a defamation lawsuit, The Guardian stated it "stands by its 'deeply sourced, independent reporting'" which is based on "thousands" of records and interviews with "more than 20" current and former employees.
- UnitedHealth denies the allegations, stating the DOJ has already "declined to pursue the matter" (referring to a previous decision not to intervene in the whistleblower lawsuits).
UnitedHealth Group Resists Shareholder Proposal on Delayed and Denied Care
UnitedHealth Group (UHG) asked the Securities and Exchange Commission (SEC) to block a non-binding shareholder proposal that would require the company to report on the broader economic and public health costs associated with its practices that delay or deny patient care. The proposal was filed by members of the Interfaith Center on Corporate Responsibility (ICCR), representing institutional investors like pensions and foundations.
- The shareholders argue that UHG, being the largest US health insurer and the 19th-largest company globally, has such significant market power that its care denial practices (like prior authorizations) could harm the overall US economy by keeping workers sick, indebted, and less productive, ultimately hurting the investors' diverse portfolios.
- UHG is the 19th-largest company in the world by market capitalization.
- More than 5% of the US gross domestic product flows through UHG each day.
- The shareholder proposal cited a 2023 KFF survey finding 18% of insured US adults reported having a claim denied in the past year.
- UnitedHealth argued the proposal should be excluded partly because terms like "public health-related costs" and "macroeconomic risks" are too vague. Update: The shareholders later withdrew the proposal after UHG challenged it twice following changes in SEC guidance, but plan to continue dialogue with the company.
UnitedHealth under scrutiny for nursing home practices
UnitedHealth Group is facing scrutiny over accusations that it provided financial bonuses to nursing homes to incentivize them to reduce the number of patients transferred to hospitals, a practice allegedly designed to cut costs.
- Families and whistleblowers allege that this practice of incentivizing fewer hospital visits has led to residents' medical issues being concealed, delayed, or denied, halting necessary treatment and placing their health at risk for the sake of profit.
- The allegations are part of a broader scrutiny into UnitedHealth's cost-cutting tactics within its Medicare Advantage plans.
- Whistleblower declarations from nurse practitioners who worked for UnitedHealth allege the company's bonus system led to "delays and denials of medically necessary care."
- Federal lawmakers, including Sens. Ron Wyden and Elizabeth Warren, have launched investigations into the practice, questioning its effect on patient safety.
- UnitedHealth has faced a defamation lawsuit against The Guardian for its original reporting on the matter, which the company called "blatantly false and misleading."
- Vincent Cinque is a family advocate whose mother and grandmother are both in nursing homes.
- Vincent's families experiences are in line with the alleged practices the senate is investigating UHG for including up-coding and minimizing hospital transfers.
- Cinque is fighting to get answers and ensure they receive the proper care, stating that their necessary treatment has been "halted for some time."
- "It Feels like the system is designed to break us, to crack us, and to make us give up. But I don't want to give up on my Mom."
-Vincent Cinque
Vincent Cinque, an advocate for his family members speaks out about his family's story
The Human Cost & Public Reaction
UnitedHealth Group is Too Big. Here's How That Puts Your Care at Risk.
The article argues that UnitedHealth Group's (UHG) massive size and vertical integration—owning insurance plans (UnitedHealthcare), PBMs (Optum Rx), physician groups (Optum Care), and technology platforms (Optum Insight, Change Healthcare)—create significant conflicts of interest. This consolidation allows UHG to prioritize its own profits over patient care, leading to issues like restrictive networks, denials of care, and inflated costs across the healthcare system.
- UHG's control over various parts of the healthcare system enables it to engage in practices that harm patients and competitors. Examples cited include using its PBM to favor its own pharmacies, employing potentially flawed AI (like nH Predict) to deny necessary post-acute care for Medicare Advantage patients, and leveraging its market power to squeeze out independent providers, ultimately reducing patient choice and potentially compromising care quality.
- UHG is the largest health insurer in the U.S. and the largest employer of physicians (Optum employs or is affiliated with ~90,000 doctors).
- Its PBM, Optum Rx, is one of the three largest, controlling a significant portion of the prescription drug market alongside CVS Caremark and Express Scripts.
- The company's immense size means its operations influence a substantial portion of the U.S. healthcare economy, raising concerns about market concentration and its negative effects on competition and costs.
Investors Call on UnitedHealth Group to Report on Public Health Costs of Care Denials
A coalition of shareholders, the Interfaith Center on Corporate Responsibility (ICCR), filed a formal proposal requesting that UnitedHealth Group's Board of Directors prepare a report on the public health-related costs and macroeconomic risks created by its own practices that limit or delay patient care.
- This shareholder proposal was filed just one month after the fatal shooting of UnitedHealthcare CEO Brian Thompson. Proponents of the proposal explicitly linked the request to this event, stating that the "public outrage over the exorbitant costs and restricted access to healthcare has reached a dangerous level".
- The proposal was filed by the Interfaith Center on Corporate Responsibility (ICCR), which represents over 300 institutional investor groups.
- It specifically asks the company to evaluate how often its prior authorization requirements and coverage denials lead to patients delaying or abandoning medical treatment, and how often they result in "serious adverse events".
- The investors argue that while denial practices may boost short-term revenue, they create long-term "reputational and legal risks" for UnitedHealth and also harm the broader economy by reducing worker productivity and consumer spending power.
- The proposal comes amid intense media and legislative scrutiny over UnitedHealth's market dominance and its alleged use of AI algorithms to deny care to Medicare Advantage patients.
Trump DOJ Gives Monopolist UnitedHealth a Green Light to Swallow Yet Another Competitor
The Trump administration's Department of Justice (DOJ) settled a Biden-era antitrust lawsuit that was originally filed to block UnitedHealth Group's $3.3 billion acquisition of the home health and hospice provider Amedisys.
- Critics, including Senator Elizabeth Warren and the American Economic Liberties Project, called the settlement "half-baked". They allege it allows UnitedHealth to divest the required locations to "similarly conflicted buyers," including a private equity firm, rather than truly restoring competition, and suggested the deal may be based on "political favors".
- The original lawsuit was filed in November 2024 by the Biden DOJ and the attorneys general of several states.
- The Biden-era DOJ warned the merger would let UnitedHealth "further extend its grip" on home health care, "threatening seniors, their families, and nurses".
- The settlement requires UnitedHealth to divest 164 home health and hospice locations across 19 states.
- A recent analysis cited in the article states that UnitedHealth Group currently has around 2,700 subsidiaries.
Opinion: A grim reminder of the health insurance industry’s human cost
The article, written by former health insurance executive Wendell Potter, argues that the "reprehensible murder" of UnitedHealthcare's CEO Brian Thompson has exposed the deep, simmering anger and frustration that millions of Americans feel toward a healthcare system they experience as being rigged against them.
- Potter, a whistleblower from Cigna, states this anger is predictable because the industry's business model is designed to deny necessary care for profit. He says it's not hyperbole to state that these companies "have acted with violence" toward patients through delays and denials that shorten lives and cause immense suffering.
- Potter notes that this public rage has been building for years as companies "as a matter of business, denied necessary care for years and years".
- He states that even when patients appeal a denial, which few do, the majority of those appeals are approved, showing that the initial denials for "medically necessary care" were wrong.
- Potter claims the insurance industry spends an "enormous amount of money" to keep this "extraordinarily profitable" system in place, prioritizing shareholders over patients.
UnitedHealth Is Sick of Everyone Complaining About Its Claim Denials
In the wake of CEO Brian Thompson's murder and the subsequent public backlash over claim denials, UnitedHealth Group has become more proactive in "confronting negative stories," including sending a letter from a defamation law firm to a doctor who spoke out against the company.
- Shareholders filed proposals seeking an audit of the company's denial rates, with one proposal suggesting that if an independent auditor finds a claim was wrongly denied, the company should "send a formal apology to those families". UnitedHealth argued against these proposals in letters to the SEC, calling them "impermissibly micromanaging" and "too vague".
- Public support for Mangione on social media, where he was called a "hero" by some, disturbed UnitedHealthcare and was a factor in the company's defensive PR strategy.
- Critics allege the company's defensive approach, like blocking shareholder proposals and sending "stern letters to doctors," suggests it is "more anxious than ever to shut down anything that might inspire the next Mangione".
- This article speaks volumes that something must be done to stop the Denial Echo Chamber that Health Insurance Companies have corrupted the appeals process into for the sake of corporate profits, fed by the lives and limbs of the patient victims.
Investors Are Pressing UnitedHealth Group to Deny More Care
Investors are suing UnitedHealth Group, not for its high denial rates, but because they are concerned the company's "corporate practices" have become "too consumer-friendly" in the face of public pressure, leading to a drop in stock value.
- The investor lawsuit explicitly admits that the company's previously "sky-high" denial rates "reaped them enormous profits," and they are now suing to stop the insurer from approving more patient care, which they see as a threat to their earnings.
- The investor lawsuit was filed after UnitedHealth's "disastrous" first quarter of 2025, which saw "cratering stock value".
- UnitedHealth Group has one of the highest denial rates of any major insurer and was one of the first to be criticized for using AI to deny care.
- A recent study (prior to the article) asserted that UnitedHealthcare denies about one in every three claims.
- The company's profits have skyrocketed, with UnitedHealth Group accounting for over 40% of the $371 billion in profits made by the top five health insurers since the Affordable Care Act passed.
A Personal Account: "My UHC denial experience"
UnitedHealthcare (UHC) attempted to deny coverage for a 4-week-long hospital stay following a severe car accident where the patient broke both hips, a foot, an ankle, and both wrists.
- UHC's "expert doctors" reviewed the case and determined that after just 24 hours, the patient—who was temporarily paralyzed from the waist down and couldn't move—no longer "needed to be there".
- The patient was left with a $40,000 bill after their auto insurance paid its portion.
- After months of fighting, UHC eventually "just stopped pursuing" the bill.
- Commenters on the post noted that UHC has the highest denial rate by far, with one user stating it is "over 30%" or "32%".
- Another user, a self-identified state insurance regulator, stated that regulators are "completely impotent" and "useless" against these company practices.
Killing of UnitedHealthcare CEO prompts flurry of stories on social media over denied insurance claims
The fatal shooting of UnitedHealthcare CEO Brian Thompson, and the discovery of shell casings with the words "deny," "defend," and "depose", unleashed a massive outpouring of public anger and frustration online, with many people sharing personal horror stories about their insurance claims being denied.
- A 2021 KFF analysis (cited in reports covering the CNN story) showed that UnitedHealth's qualified health plans in Arizona denied almost 39% of in-network claims. This was more than double the average denial rate of 17% for comparable plans nationwide that year.
- A U.S. Senate subcommittee report found UnitedHealthcare's prior authorization denial rate for post-acute care doubled from 10.9% in 2020 to 22.7% in 2022.
- A 2023 KFF survey found that nearly 1 in 5 (18%) insured adults reported having a claim denied in the past 12 months.
- A new poll found that about 7 in 10 U.S. adults believe that "denials for health care coverage" and "profits made by health insurance companies" bear at least a "moderate amount" of responsibility for Thompson's death.
- Americans under 30 were especially likely to attribute blame, with about 7 in 10 saying that insurance denials and profits are about as responsible as the killer for his death.
United Healthcare WHISTLEBLOWER Reveals Fraud, Forced Claim Denials
A former UnitedHealthcare (UHC) medical claims employee alleges she was "taught so many different ways to deny" claims]. She describes a specific case where the company was fighting "tooth and nail" to deny a hospice claim for a man who had died of pancreatic cancer, leaving his widow with five children to face court action and wage garnishment, [05:33], [05:46].
- The whistleblower alleges a fraudulent practice where she was "approved a certain amount of monies" per day]. This daily budget—not the medical merits of the claims—dictated what she could pay, meaning if one large claim was paid, no other claims could be, regardless of their validity. She describes this as "Health rationing" and "fraud", [08:22]
- The whistleblower claims supervisors would stand behind employees and laugh while the employees were crying on the phone with members, [02:31].
- She alleges that in the case of the widow, UHC was trying to force the single mother to pay a bill of around $400,000 or $500,000.
- The video also references a separate poll from NOC at the University of Chicago, which found that about 8 in 10 US adults said the killer of the UHC CEO has responsibility, but 7 in 10 adults also say that "denials for health care coverage" and "profits" bear at least a "moderate amount of responsibility" for the death, [01:14:18], [01:14:25].
Whistleblower Exposes Health Insurers' Most Evil Scheme
A whistleblower, "Max," who worked for a third-party company that handles prior authorizations, states the infamous "deny, delay, and defend" strategy is an "unspoken understanding", [07:15]]. He reveals that management would never explicitly say "let's deny more requests," but would instead say, "let's send more requests to review," knowing this would achieve the same outcome, as many patients would simply give up on the process.
- The video details the case of Kathleen Valentini, whose doctor ordered an MRI for hip pain. The prior authorization was denied, and the 5-week delay to appeal the decision allowed her fast-growing cancer (sarcoma) to spread, [01:51], [01:59]]. As a result of the delay, she was forced to have her entire leg amputated and was eventually killed by the aggressive cancer, [09:59].
- An American Medical Association survey found that 80% of doctors report patients have "abandoned their treatment" because of the prior authorization process.
- The same survey found 19% of doctors say prior authorizations have led to "life-threatening events" or required intervention to "prevent permanent impairment or damage".
- A family doctor describes a prior authorization denial for a wheelchair for her patient who just had both of his legs amputated]. The denial reason was that she "didn't specify how his walking would be affected by his disability".
The $1 Trillion Private Health Insurance Scam
The video argues that the privatized Medicare Advantage (Part C) program costs taxpayers significantly more and provides worse care than the traditional, public Medicare (Parts A and B) [07:04].
- Medicare Advantage plans systematically deny necessary medical care that traditional Medicare would have otherwise approved and covered. The video highlights a study where nearly 15% of 5.6 million care denials were attributed to Medicare Advantage's more restrictive policies [07:52], a situation the narrator personally experienced when his mother was denied rehab facility care in her final days [00:11].
- Traditional public Medicare spends 98.6% of its budget on patient care, with only 1.4% going to administrative costs [01:51].
- For-profit Medicare Advantage plans, by contrast, spend only 85% on care, with 15% going to administrative costs, executive salaries, and profits—10 times higher than the public option [09:04].
- Medicare Advantage plans cost taxpayers an estimated $300 to $1,000 more per patient than traditional Medicare [07:13].
- Americans are expected to pay nearly $1 trillion in taxpayer money just for overpayments to these private insurance programs in the coming years [07:28].
Hear Two UnitedHealthcare Representatives Discuss Someone’s Health Insurance Case
A ProPublica investigation details the story of Chris McNaughton, a college student with ulcerative colitis, who sued UnitedHealthcare after the insurer denied coverage for his essential, life-saving medication by claiming it was "not medically necessary," despite it being the only treatment that worked after all others had failed [00:21].
- Through the lawsuit, the patient obtained an internal phone call where two UnitedHealthcare employees were recorded laughing about the denial of his claim [00:09].
- The patient's medical bills were nearly $2 million a year when UnitedHealthcare flagged his account and denied payment [00:45].
- A UnitedHealthcare doctor admitted under oath to signing over 10,000 denials for the company, stating he often didn't look at the medical records and would "cut and paste" denial language from a nurse's notes [01:01].
- The lawsuit revealed that when UnitedHealthcare paid for a doctor's opinion that agreed with the patient, the company ignored and buried that report [01:21].
Watch ProPublica's Coverage on YouTube →
Read ProPublica's Coverage on YouTube →
Read Kare 11's News Coverage →
Read Uscher, Quiat, Uscher & Russo's Blog about United Healthcare's shamfeul and cruel tactics →
Letter to UnitedHealthcare on Retroactive Denial of Coverage for Emergency-Level Care
In a June 2021 letter, the American Hospital Association (AHA) strongly urged UnitedHealthcare (UHC) to "immediately reverse" its new policy that allows the insurer to retroactively deny coverage for emergency room visits it deems non-emergent after the fact.
- The AHA warned that this policy is "dangerous for patients' health" because it threatens them with a financial penalty for seeking care. This could have a "chilling effect," causing patients to second-guess themselves and avoid the emergency room during what they believe is a medical emergency, which is "particularly unsafe" given that deferred care has already led to adverse health conditions.
- The AHA points out this financially-motivated policy comes as UHC's parent company, UnitedHealth Group, posted a 35% year-over-year jump in operating profits in the first quarter of 2021.
- In that same quarter, UnitedHealth Group earned $6.7 billion in profit.
United Healthcare Insurance a Scam Allowed to Happen
Data indicates that UnitedHealthcare denies about one-third of all submitted claims, a rate that is double the industry average.
- A 2023 class-action lawsuit alleges that UnitedHealthcare's AI algorithm, known as "nH Predict," has a 90% error rate and has been used to unjustly deny coverage, particularly for elderly patients requiring post-acute care.
- UnitedHealthcare denies approximately one-third (33%) of all claims submitted.
- UHC's claim denial rate is double the industry average.
- The "nH Predict" AI model allegedly has a 90% error rate.
- UnitedHealth Group, the parent company, reported a gross profit of approximately $90.1 billion for the twelve months ending September 30, 2024.
UHC, Denials, and Wrongful Death Revisited
The article is a philosophical exploration of whether a health insurance denial can be morally equivalent to a "wrongful death." The author argues that to justify the killing of CEO Brian Thompson, one would have to prove he was personally and systematically responsible for wrongful killings through specific types of denials (like prior authorization denials for life-saving care), a connection the author finds plausible but ultimately unproven.
- The author, who works in hospital denials management, states that even at a low level, "the bad faith and deception" of insurance companies are "totally transparent" and describes a common scenario where an insurer denies a clearly covered, necessary, and expensive procedure as "not medically necessary," which they know is false.
- The author distinguishes between "claim denials" (denying reimbursement after treatment is given) and "prior authorization denials" (denying treatment before it is given).
- The author argues that only prior authorization denials for life-saving procedures could plausibly be considered "wrongful killing," whereas claim denials (which happen after the patient is cured) cannot.
- The author notes that UHC's overall denial rate is high, but its prior authorization rate is "relatively low" compared to other insurers like Humana, which "might suggest prima facie that Humana's CEO would have been a better target."
- The author posits that "lack of insurance is a bigger driver of mortality (if anything is) than wrongful-death denials among the insured."
INHUMANE: UnitedHealth Group REJECTS 1 out of 3 Medical Claims
The video details UnitedHealth Group's "vertical integration" strategy, a business model designed to get "a cut of every single step of the healthcare process." This includes owning the insurer (UnitedHealthcare), the pharmacy (Optum Rx), and the doctors themselves, with its subsidiary Optum being the largest employer of physicians in the United States [06:04].
- UnitedHealthcare's high rate of claim denials is presented as a deliberate strategy to starve doctor's offices of cash, forcing them to take out predatory "payday loans" to stay afloat. United's own subsidiary, Optum, offers one of these loan services, directly profiting from the financial distress it creates for medical providers [05:33].
- The video highlights that UnitedHealthcare denies nearly 1 in 3 (32%) of all medical claims [03:45].
- The general industry average for claim denials is nearly 1 in 5 [03:34].
- UnitedHealthcare is the largest employer of physicians in America, with 70,000 doctors on its payroll [06:04].
- One report found that 41% of healthcare providers had to take out external loans to stay financially afloat, a problem exacerbated by insurer's denial practices [05:07].
Bipartisan Support for Policies that Protect People from Medical Debt
There is overwhelming bipartisan support among voters for new legal protections against medical debt, with large majorities favoring government action to shield patients from unaffordable costs.
- A significant portion of voters (35%) reported currently owing money or having debts due to medical or dental expenses, indicating that even having health insurance often fails to protect people from burdensome medical debt.
- 84% of voters believe having health insurance should protect people from medical debt.
- 74% believe the current health insurance system is "mostly failing" at protecting people from medical debt.
- The majority of voters blame the insurance industry primarily for medical debt issues, rather than hospitals or drug makers.
- There is strong bipartisan support for specific policies, such as removing medical debt from credit reports and setting limits on hospital charges.
- The poll surveyed 1,319 general election voters between August 21 and September 2, 2025.
External Health Insurance Watchlists & Resources
UnitedHealth Group Abuse Tracker →
Maintained by: American Economic Liberties Project (AELP)
This resource compiles news reports, legal filings, and analyses concerning alleged anticompetitive practices, patient care issues, and market power abuses involving UnitedHealth Group and its various subsidiaries across the healthcare industry.
HEALTHCARE - People Over Profit
The page details multiple "Deaths by Denial," providing specific examples of patients (Little John Cupp, Nataline Sarkisyan, Tracy Pike) who died after insurance companies like United Health Care, CIGNA, and Blue Cross Blue Shield repeatedly denied their doctors' requests for life-saving or necessary medical treatments, often deeming them "not medically necessary."
- A 2023 class-action lawsuit alleges United Health Group uses an AI algorithm, "nH Predict," to illegally deny care to elderly patients, despite the algorithm having a 90% error rate. The lawsuit claims UHC knows the algorithm is flawed but uses it anyway, aware that only a small percentage of patients will appeal.
- UnitedHealth has a 32% claims denial rate, which is twice the industry average and represents nearly one in three claims being denied.
- The "nH Predict" AI algorithm allegedly has a 90% error rate, based on the percentage of payment denials that are reversed through the internal appeals process.
- One "medical benefits management company" (EviCore) that insurers hire to deny claims advertises to them a 3-to-1 return on investment.
- A 2022 survey of oncologists found that 42% of prior authorizations were delayed, with doctors attributing "loss of life" to these delays 36% of the time.
The Rise of the Healthcare Influencers
30 Days of US Healthcare:Day 26: United Healthcare Denies Everything
The video is a satirical sketch that portrays a private health insurance employee denying a wide range of necessary medical treatments and medications for absurd and bureaucratic reasons, highlighting the frustrations patients and doctors face [00:00].
- The sketch illustrates insurance representatives denying life-sustaining care, including telling a patient they must wait 6-8 weeks for an appeal for insulin [01:06] and refusing to approve a new battery for a pacemaker, suggesting "maybe the heart's figured it out by now" [01:45].
- Denial of a CT scan for cancer surveillance [00:32].
- Denial of a brain tumor scan, with the suggestion it might "go away on its own" [00:39].
- Denial of rehab facility care because the employee "didn't get the vibe" that the patient would rehab well [00:48].
- Requiring a patient to prove they still have Type 1 diabetes to get their insulin prescription refilled [02:01].
- Requiring a patient to "fail" two other ADHD medications before approving the one they have been stable on for a year [02:12].
30 Days of US Healthcare:Day 12: Automated Claim Denials
The video is a satirical sketch depicting an insurance company that uses an "automated system" to flag claims, which are then "reviewed" by medical directors who deny them all without looking at any clinical documentation [00:25], [00:45].
- The company's goal is to save money by "blanket denying everything," because the appeal process is intentionally made so confusing that only 5% of all denied claims are ever appealed, forcing customers to pay out of pocket or "go bankrupt" [01:12].
- The fictional company denied over 300,000 claims in two months [00:00].
- The "medical directors" can deny a claim in 1.2 seconds [00:59].
- Only 5% of denied claims are appealed due to the confusing process [01:19].
- The company boasts that its doctors "click so fast" they need treatment for index finger arthritis, which is "not covered by insurance" [01:06].
30 Days of US Healthcare:Day 5: Prior Authorizations
The video is a satirical sketch that portrays the invention of "prior authorization" as a deliberate strategy by an insurance company to "wedge ourselves into industries we know nothing about" and force doctors to ask for permission before providing "anything" to a patient [00:29], [00:41].
- The characters in the sketch openly acknowledge that by denying authorizations, they are "practicing medicine without a license" [01:10]. They also admit their denials either prevent patients from getting needed treatment or leave them "financially devastated" if they get the care anyway [00:56].
- The policy was created to challenge doctors who believe their "decade of medical training" gives them the right to order necessary tests or treatments for their patients [00:16].
- The characters admit the policy is not for rare, expensive treatments but is a tool to "generate wealth by needlessly delaying routine medical care" [01:24].
- The practice is justified with the logic: "it's legal and it makes us money, therefore it's good" [01:10].
Dr. Exposes UnitedHealthcare in ONE Call!
The video features a "peer-to-peer" call where a plastic surgeon, Dr. Elizabeth Potter, records a UnitedHealthcare (UHC) doctor attempting to deny a preventative lymphedema surgery for her breast cancer patient. Dr. Potter exposes the UHC doctor as unqualified to make the decision, as he is not a "peer" in this specialty, has never performed the procedure, and does not treat lymphedema or breast cancer patients [00:04], [02:32], [03:03].
- The UnitedHealthcare doctor on the call, who is an "ocular plastic surgeon" (eyelid surgeon) and unfamiliar with lymphedema of the arm, refuses to provide his name to Dr. Potter, claiming it is for his own protection [00:00], [00:50], [01:03].
- Dr. Potter states her patient has a 40% risk of developing lymphedema following her required cancer treatment [04:14].
- The requested preventative surgery, lymphovenous bypass, would reduce the patient's risk of lymphedema from 40% down to 10% [04:14].
- The video alleges that UnitedHealth has lost over 50% of its profit since its CEO's death and is under investigation by the Department of Justice for alleged fraud in its Medicare program [05:43].
- UnitedHealthcare sent Dr. Potter a letter demanding she take the video down and publicly apologize, which she refused to do [05:05].
United Healthcare Denials
According to data from ValuePenguin, United Healthcare denies 32% of all claims, a rate that is "significantly higher than industry averages" and almost 50% higher than the industry standard.
- The article states that for surgeons providing elective care, the denial rate from United Healthcare can "soar to 80%."
- United Healthcare denies 32% of all claims.
- The denial rate for elective surgery can be as high as 80%.
- Nearly half of all denied claims stem from the prior authorization process.
- The article lists "AI-Driven Claim Denials" as a systemic strategy insurers use, where autonomous systems reject claims "without proper contextual understanding."