UnitedHealth is target of DOJ probe for antitrust violations related to its Optum unit
In recent weeks, the Justice Department has been interviewing health care industry representatives in sectors where UnitedHealth competes to determine if the health care giant favored its Optum-owned doctor groups.
The U.S. Justice Department is conducting an antitrust investigation into UnitedHealth, owner of the biggest U.S. health insurer, and specifically into UnitedHealthcare’s relationship to its Optum business unit, according to a Wall Street Journal report.
In recent weeks, the inquiry is partly examining Optum’s acquisitions of doctor groups and how the ownership of physician and health-plan units affects competition, sources told the Journal. Investigators have asked whether UnitedHealthcare favored Optum-owned groups in its contracting practices, potentially squeezing rival physicians out of certain types of attractive payment arrangements.
Although both the Justice Department and the company declined to comment, executives have said Optum and UnitedHealthcare don’t favor one another and routinely work with competitors. The probe comes as the Biden administration’s antitrust enforcers have stepped up investigations of some of the largest U.S. companies and signaled that the health care industry is a priority in its antitrust efforts.
UnitedHealthcare has been under scrutiny on several legal fronts in recent years.
- In 2022, the Justice Department lost a challenge aimed at blocking Optum’s acquisition of health-technology firm Change Healthcare. In that case, the Justice Department focused on the alleged anticompetitive potential of putting the insurer and Change under the same corporate parent.
- The department has been scrutinizing UnitedHealth’s planned acquisition of home-health company Amedisys for about $3.3 billion. Amedisys said last August that it had received a second request for information about the proposed deal from Justice Department antitrust enforcers.
- A private antitrust suit by the California hospital system Emanate Health alleges that the company tried to strong-arm the nonprofit over its affiliated physician groups and exert control over primary care doctors in its region.
- Justice Department officials are investigating Medicare billing issues, including the company’s practices around documenting patients’ illnesses. Payments to Medicare plans go up if patients have more health conditions, so aggressive documentation practices by doctors and other health-care providers can be lucrative for insurers such as UnitedHealthcare.
- Investigators have asked whether and how the link between UnitedHealthcare and Optum medical groups might affect its compliance with federal rules that cap how much a health-insurance company retains from the premiums it collects from customers.
Related: Optum Rx, UnitedHealth’s PBM, sued by independent pharmacy over backdoor fees
In addition to these legal battles, pharmacies nationwide reported delays in filling prescriptions last week following cyberattack against Change Healthcare.
UnitedHealthcare had $372 billion in revenue last year. Its insurance unit covers about 53 million people across a range of plans, including employer, Medicaid and Medicare coverage. After years of acquisitions, Optum includes about 90,000 physicians, as well as surgery centers, an array of health data and technology units, and one of the largest pharmacy benefit managers.