UnitedHealth Group (UNH) Prepares for Operational Changes Following External Audit

UnitedHealth Group Incorporated (NYSE:UNH) is included among the 7 Best Fortune 500 Dividend Stocks to Invest in Now.

UnitedHealth Group Incorporated (NYSE:UNH) is a US-based multinational company focused on health insurance and healthcare services.

According to a December 19 report by Reuters, UnitedHealth Group Incorporated (NYSE:UNH) said audits conducted by outside consulting firms will lead to operational changes across its health services and pharmacy benefit units. The company said those changes will include more automation and greater standardization of internal processes.

CEO Stephen Hemsley pledged earlier this year to review the business after UnitedHealth Group Incorporated (NYSE:UNH) missed its own profit forecast for the first time since 2008. During the first-quarter earnings call, executives pointed to pressure from government reimbursement rates and an unfavorable mix of new patients at Optum Health as the main reasons for the shortfall.

UnitedHealth Group Incorporated (NYSE:UNH) delivers clinical services through Optum Health, operates the pharmacy benefit manager OptumRx, and runs the insurance arm UnitedHealthcare. One of the reviews, conducted by FTI Consulting, found that in some cases the company lacked standardized documentation. This included parts of its in-home health assessment program, which submits patient diagnoses used to calculate Medicare Advantage payments to providers. Hemsley said in a letter that UnitedHealth plans to share the results of the visit review in the first quarter of 2026.

UnitedHealthcare administers Medicare Advantage plans for seniors and people with disabilities on behalf of the government and has faced scrutiny over payments that Optum receives from the insurer. The company has denied any wrongdoing but disclosed in a July filing that it is cooperating with both criminal and civil investigations by the Justice Department related to its Medicare Advantage billing. FTI said its review did not assess legal compliance.

A separate report by Analysis Group focused on OptumRx and concluded that the pharmacy benefit unit could benefit from more standardized audit practices and expanded use of automation.

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