Recently, UnitedHealth’s stock price dropped more than 22 percent, the most it has dropped in 25-plus years. The corporation’s stated reason was that enrollees are using more care. But, UnitedHealth either knew that the government payment system to Medicare Advantage insurers was changing two years ago and didn’t account for that cut in payments in its financial projections, or it didn’t factor the change into its financial projections and desperately needs new auditors. Either way, UnitedHealth continues to profit to the tune of $6.4 billion in the first quarter of 2025, writes N. Adam Brown on MedPageToday.
UnitedHealth’s CEO, Andrew Witty, said the problem was “unacceptable” but fixable, in a call with shareholders. Of course, it is fixable. UnitedHealth can profit to its heart’s content very simply. All it need do is delay and deny more care, shrink its provider networks, and make it even harder for its enrollees to get the treatments they need.
Witty’s point appears only to be that his company is not profiting as much as he would like because it has made it too easy for enrollees to get care. That said, its enrollees (along with enrollees in most Medicare HMOs) with cancer, heart disease and stroke, as well as enrollees needing rehab and other costly services, often struggle to get a doctor’s appointment and face lots of delays and denials of care.
In theory, there are federal Medicare constraints on UnitedHealth so that enrollees are protected and are not wrongly denied care. In practice, the Centers for Medicare and Medicaid Services (CMS) does not have the wherewithal to oversee the more than 4,000 Medicare HMOs covering about half the Medicare population. While networks have to be adequate, CMS is hard-pressed to ensure they are. Similarly, CMS cannot ensure that the Medicare insurers are covering the care they are required to cover, and the HHS Office of the Inspector General has found widespread and persistent inappropriate delays and denials of care that traditional Medicare covers.
To limit care and maximize profits, UnitedHealth uses prior authorization, restricts the number and quality of providers in its network, makes it hard for enrollees to get their questions answered from its call center, and denies care. They are all business strategies, Brown explains.
Humana and CVS are also facing lower profits in Medicare Advantage and are likely to do what they can to restrict utilization of services for their Medicare HMO enrollees. They have been found to use the same tactics as UnitedHealth to maximize profits, failing at times to deliver enrollees in their Medicare HMOs the care they need and to which they are entitled.
Here’s more from Just Care:
- Senator Grassley takes on UnitedHealth Medicare Advantage overpayments
- Does UnitedHealth use flawed AI to deny care in Medicare Advantage?
- Will UnitedHealth stop denying care inappropriately or simply deny doing so?
- Senate investigation shows high Medicare Advantage denial rates for costly care
- Medicare Advantage inappropriate denials of care abound
