UnitedHealth Group has come under scrutiny in a new study that reveals the conglomerate pays its own physician practices significantly more than it pays competing practices. The study, published in Health Affairs, found that UnitedHealth’s insurance arm, UnitedHealthcare, pays practices under its UnitedHealth-owned Optum umbrella 17% more on average for common services compared to non-Optum practices in the same region. In areas where UnitedHealthcare has a large market share, it pays Optum practices a staggering 61% more.
This study, led by Daniel Arnold, was inspired by previous reporting from STAT, which uncovered that UnitedHealthcare paid 13 out of 16 Optum practices more than other practices in the same market. The payment differentials ranged from as little as 3% more to a whopping 111% more. Some Optum practices were paid up to two times the market average for certain services, according to STAT’s findings.
This disparity in payment rates has raised concerns about potential violations of rules designed to prevent health insurers from excessively profiting. By paying its own practices significantly more than competing practices, UnitedHealth may be gaining an unfair advantage in the market. The study’s results further highlight the need for greater transparency and oversight in the healthcare industry to ensure fair competition and equitable reimbursement for all providers.
These findings underscore the importance of ongoing monitoring and regulation to prevent anti-competitive practices that could harm patients and undermine the integrity of the healthcare system. As the debate over healthcare costs and access continues, it is crucial for policymakers, regulators, and industry stakeholders to address these payment disparities and work towards a more equitable and sustainable healthcare system for all.
