UnitedHealth Group Scrutinized for Alleged Antitrust Practices
The antitrust practices may have not only squashed competition with competitors, but also allowed the major payer to skirt around certain regulations.
The Department of Justice (DOJ) is investigating antitrust allegations against UnitedHealth Group, with a specific focus on the ties between UnitedHealthcare and Optum, according to a Wall Street Journal article that broke the story.
Optum’s physician group acquisitions are at the center of DOJ’s inquiries as well as how the company’s provider-payer model might impact its compliance with certain regulations, people familiar with the matter told the Wall Street Journal.
Optum has accumulated 90,000 physicians over the years. Investigators are exploring how these acquisitions have impacted local competition among providers and payers, specifically whether the insurer was biased toward Optum contracts. The inquiry probed how Optum has impacted health insurance markets as well.
Additionally, the combined companies may have pushed heavier documentation practices among providers to increase Medicare payments, the Wall Street Journal reported.
Investigators are also considering whether UnitedHealthcare gained an advantage from ties with Optum, turning a profit from premiums.
By law, payers can only keep 15 or 20 percent of Medicare premiums. But if a payer also owns the provider that gets reimbursed for the service, can the health plan skirt around this rule and absorb more premium dollars? The probe may seek to answer that question, the Wall Street Journal noted.
The investigation was already underway when the story broke in late February 2024. Investigators had been questioning other healthcare stakeholders for weeks. Simultaneously, the payer is juggling a DOJ evaluation of its planned acquisition of Amedisys and a private antitrust suit alleging the health insurer pressured providers California.
The investigation comes on the heels of a dissolved Cigna-Humana megamerger at the end of 2023. It also follows news that Elevance Health paused the acquisition of Blue Cross Blue Shield Louisiana (BCBSLA) for a second time, an embattled acquisition that has faced public scrutiny for its potential to squash competition in the state.
Other major payer deals, however, have remained uncontested in 2024 such as HCSC’s acquisition of Cigna’s Medicare business for $3.3 billion and Elevance Health’s plans to acquire an infusion therapy provider.
