By Kristin Rowan, Editor
History
The Biden administration has recently increased its efforts at antitrust enforcement against some of the largest companies in the U.S. These include Apple, Amazon.com, Live Nation Entertainment, and Alphabet’s Google unit. The enforcement of antitrust laws would restrain monopolies in the U.S. Thus far, the Justice Department has had questionable success in stopping mergers, but continues its crusade on monopolies. The administration has stated the the healthcare industry is a priority in its antitrust efforts.
The Wall Street Journal reported on February 27, 2024, that a new Antitrust investigation has been launched into UnitedHealth. This is not the first antitrust action against UnitedHealth Group. In 2022, the Justice Department sued to block UnitedHealth’s plan to buy Change Healthcare. That lawsuit was unsuccessful.
Current Action
According to the WSJ, The Justice Department has spent the last few weeks interviewing industry representatives in markets where UnitedHealth operates.
Investigators asked about relationship between UnitedHealth and Optum, the health-services arm of the company, which owns physician groups, surgery centers, and pharmacy-benefit managers. They specifically asked about the effects on the doctor-group acquisitions on rivals and consumers.
UnitedHealth has been under scrutiny for some time by the Justice Department. They have twice asked for information about the planned merger with Amedisys, a home health company. UnitedHealth is also facing a private antitrust lawsuit by a hospital system in California, siting strong-arm tactics to exert control over its affiliated physician groups and primary-care doctors.
Additional Inquiries
The DOJ isn’t stopping at antitrust probes. A concurrent investigation is looking into UnitedHealth’s Medicare billing issues, including documentation of patients’ illnesses. The more health conditions a patient has, the higher the Medicare payments. The DOJ is looking into “aggressive documentation” practices by UnitedHealth doctors and other healthcare providers.
Additionally, the merger between UnitedHealthcare and Optum medical groups could violate federal rules that cap the amount a health-insurance company retains from premiums. Health insurance plans should keep 15-20 percent of premiums for administrative costs, with the balance spent on patient care or sent as a rebate back to customers. Because UnitedHealthcare keeps their percentage of premiums and collects additional money from Optum, they may be well above the federal cap.
Response
UnitedHealth has denied any antitrust claims, stating that United Health and Optum don’t favor one another, and routinely work with competitors. UnitedHealth Chief Executive Andrew Witty testified that Optum has an “arm’s length relationship” with United Healthcare.
In an ongoing investigative series about CareMount/Optum, The Examiner News reporter Adam Stone, spoke with an anonymous insider who said, “If they are stopped before they become a monopoly, than that’s great, but they are headed down that road.” That same source has reported massive layoffs, mostly among C-suite executives, in the wake of the antitrust “document preservation notice” from the DOJ.
We will continue following the antitrust lawsuit and the objection to the merger with Amedisys.
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Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com
©2024 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in Healthcare at Home: The Rowan Report.homecaretechreport.com One copy may be printed for personal use: further reproduction by permission only. editor@homecaretechreport.com
Sources:
Mathews & Michaels. February 27, 2024. U.S. Opens United Health Antitrust Probe. Retrieved from: https://www.wsj.com/health/healthcare/u-s-launches-antitrust-investigation-of-healthcare-giant-unitedhealth-ff5a00d2?st=30zpi0dw9hktzlj&reflink=desktopwebshare_permalink
Stone. February 26, 2024. Justice Department Probing UnitedHealth/Optum Over Antittrust Concerns; Local Layoffs Enacted, More Forecast. Retrieved from: https://www.theexaminernews.com/justice-department-probing-unitedhealth-optum-over-antitrust-concerns-local-layoffs-enacted-more-forecast/
