Overview
As a result of an independent audit aimed at assessing the business practices of UnitedHealth Group, the examination has been completed, and the outcomes have been disclosed. Following third-party reviews and continuous internal scrutiny, the company announces its intention to implement 23 action plans to make process changes and increase the employee engagement level in different business units. Most of the changes are to be in place by UnitedHealth by the end of 2025, while all the improvements are scheduled for early 2026.
The main reason for the audit
The audit was conducted after the announcement of the first profit miss of the last several years of UnitedHealth. Among other things, executives and the outside reviewers have located documentation and operational consistency areas, especially in-home healthcare programs and pharmacy benefit operations, where problems have arisen. The company will utilize these audit results to bring operations to a higher level of efficiency through the changes it intends to make.
Action Plans and Timeline
UnitedHealth Group has come up with 23 action plans to address the organization’s issues and improve procedures. The report on the audit results states that the management is going to implement approximately 65% of these actions in 2025, with all recommendations being carried out by March 2026. One example that was mentioned to clarify the point was the absence of standardized documentation for the HouseCalls program. Through this program, healthcare professionals perform assessments for Medicare Advantage members, a procedure that affects how the government calculates its payments. The executives pointed out that not only would more detailed documentation help the exact delivery of care, but it would also make the reimbursement process more accurate.
Operational Improvements
UnitedHealth plans to improve its business units’ processes through automation and standardisation by introducing uniform practices across different units. In other words, the changes will affect not only the company’s health services operations but also the pharmacy benefit management unit, OptumRx. The planned changes will help by reducing errors, increasing efficiency and providing better documentation. Additionally, the company intends to make the most important aspects of its HouseCalls study public in the first quarter of 2026. Among other things, the executives highlighted the importance of the renovations in making the company more transparent and in increasing the control inside the company.
Regulatory Context
Although UnitedHealth has been very clear that it has done no wrong in terms of billing practices, it is still cooperating with the civil and criminal investigations of the U.S. Department of Justice. The investigations have been focused on the methods the insurer uses in Medicare Advantage billing. However, the audits, which are not compliance checkers, are among the ways the company is responding to external pressures.
Market Reaction
After the announcement of the audit and the action plan, UnitedHealth’s stock price reflected relatively stable pre-market trading. Some retail investors, however, voiced bearish sentiment, referring to the ongoing investigations and industry pressures as reasons.
