UnitedHealth's physician group ownership targeted in antitrust investigation

UnitedHealth Group is the target of a Justice Department antitrust investigation, according to The Wall Street Journal. Investigators are zeroing in on the company's ownership across sectors, including physician groups, pharmacy drug benefits and a major health plan.

UnitedHealth Group has two major divisions: UnitedHealthcare, its health plan, and Optum, which includes its pharmacy and physician services groups. Optum owns primary care and specialty physician groups, as well as SCA Health, a network of more than 320 ASCs and surgical facilities.

As of last November, Optum had 90,000 physicians including 9,200 affiliated with SCA Health, making it one of the largest physician networks in the country.

Optum also includes Change Healthcare, a claims processing platform used by more than 70,000 providers. Change was hit by a cyberattack Feb. 21, and the IT system recovery is ongoing.

The DOJ is questioning UnitedHealth about the relationship between Optum and UnitedHealthcare, and the effect physician group acquisitions have on local communities. Optum's physician groups serve patients covered by UnitedHealthcare plans as well as competing health plans. However, investigators are examining whether UnitedHealthcare favors Optum-owned physician practices, which could hurt competing practices.

Investigators are also taking a look at Optum-owned medical groups' billing practices to determine compliance with federal rules capping the amount health insurance companies can retain from premiums collected, according to the Journal. The cap is 15% to 20% of premiums retained for administrative costs and profits, but the combined company "may absorb far more than the capped amount," according to the report.

This isn't the first time UnitedHealth has been questioned about antitrust issues. The federal government challenged Optum's combination with Change Healthcare two years ago, but the transaction was eventually approved.

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Webinars

Featured Whitepapers

Featured Podcast