UnitedHealth Group Publicity Stunt

by Kristin Rowan | Jan 30, 2026 | CMS, Editorial, Medicaid, Medicare, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

UnitedHealth Group Publicity Stunt

How to Distract the Public: 101

When customers and regulatory bodies start to complain about company practices, reputation management usually gets involved. An internal or external public relations, crisis communication, and/or reputation management specialist advises the company on how to overcome negative press.

Transparency & Action

When Dominos Pizza employees recorded a disturbing “hoax” video, the CEO went to the same medium (YouTube) to address the video, apologize, and reassure customers. This issue was handled so well that it is used as a teaching tool in PR classes.

In 1982, when a couple tampered with bottles of Tylenol in Chicago and seven people died, parent company Johnson & Johnson stopped advertising, recalled 31 million bottles across the country, switched to tamper-proof packaging, and personally communicated with 450,000 retailers.

Subterfuge, Smoke & Mirrors

Last week, when UnitedHealth Group, already under investigation for bribing nurses, wrongful death, and Medicare Advantage billing fraud, was called to testify before House committees about their record-high premiums, rising claims denials, and unneccessary waiting over prior approvals, UHG CEO prepared a written statement to read to the Energy & Commmerce Committee that included blaming hospital costs, pricing differences, frequency of testing, drug prices, and pharmaceutical advertising for higher premium rates; extolling the virtues of Medicare Advantage over Traditional Medicare, using incorrect and misleading information; and casually mentioning that they will “voluntarily eliminate and rebate our profits” for their ACA customers.

Gesture too Small to be Meaningful

The months long Congressional stand-off on healthcare premium subsidies continues. Affordable Care Act participants saw healthcare premiums jump over night when the subsidies expired. (Mine went up 400%).

In 2025, UnitedHealth recorded $12.1 billion in profit. But, that profit is spread out over nearly 3,000 wholly owned subsidiaries who take almost 30% of what UHG pays out in care costs. The company has increased its Medical Loss Ratio to 87% by hiring their own subsidiaries to engage in “quality improvement,” virtually eliminating ACA profit.

Of its 50 million subscribers, only about 1 million are ACA customers. Even if the company returns the ACA profits, it will return 1/50th of its profits and keep the rest. In their third quarter earnings call, UHG said it expected 2026 enrollment to be 1/3 of that in 2025. The 2026 outlook estimates an overall increase in profit to more than $14 billion, most of which will never find its way back to ACA participants.

The Truth Behind the Curtain

On January 27, 2026, just one week after the profit-sharing announcement, UnitedHealth Goup addressed shareholders in its Q4 and 2025 Earnings Call. During that call, newly appointed UnitedHealthcare CEO Tim Noel said:

“Nearly all of our employer Group and fully insured pricing align with continued increases in care activity for 2026. In the Individual ACA market, we repriced nearly all states in response to higher medical trends and the elevated needs of ACA beneficiaries in 2025…. These actions should expand operating earnings margins for UnitedHealthcare by 40 basis points, and are expected to result in membership contraction of 2.3 to 2.8 million.”

Tim Noel

CEO, UnitedHealthcare

Other statements during the call reinforced the company’s drive toward profit.

They are focusing attention in markets where they have “complimentary wrap-around services” already in place. Which means they have owned subsidiaries to shift money to instead of lowering premium rates. Additionally, they have “narrowed [their] affiliated network…with the goal of having a more optimal alignment of physicians….”

New Speak

Throughout the earnings call, company spokespeople used terms like repositioned, streamlined, aligned, membership contraction, and repriced. They carefully avoided saying that they dropped physician services outside those they owned, removed plans that paid out too much, consolidated businesses to increase profits, lost millions of members due to price increases and other plan problems, and raised prices across the board, even on plans that were already profitable.

Final Thoughts

UHG CEO Hemsley made a few statements to Congress I agree with. Drug prices are too high. Hospital and Ambulance prices are too high. Pharmaceutical companies advertise too much and use the cost to offset tax liability.

There were also some statements Hemsley almost got right.

He said small businesses should be allowed to join AHPs with fewer restrictions. There should be no restrictions on industry or geography.
He said HSA thresholds should be lowered for HDHPs. HSAs should be available to everyone, regardless of plan, deductible, payer, or whether they are on a group, individual, or ACA plan.
Hemsley thinks broker compensation should be standardized in the ACA market. If payers want broker compensation, standardized or not, ACA or Medicare Advantage, the compensation should come from the payer and not be included in premiums.
He wants consumers to have expanded access to catastrophic plans and to allow the use of premium tax credits. All plans and payers should be available to everyone, everywhere. Increasing competition in plans and players will drive down costs.

I applaud Congress for bringing the large payers in to discuss exhorbitant premium rates, but I’m still waiting on them to take action based on the information they received.

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Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites. Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

UnitedHealth Causes Heightened Alarm

by Kristin Rowan | Jan 9, 2026 | Breaking News, CMS, Legal, Medicare Advantage, Outcomes, Regulatory

by Kristin Rowan, Editor

UnitedHealth Causes Heightened Alarm

Guardian Investigation Launches Probe

In July of 2025, The Guardian reported that UnitedHealth had secretly paid nursing homes to reduce hospital transfers. The investigation revealed that UnitedHealth was placing its own medical teams inside nursing homes and pushing them to cut care expenses, delay transfers, and deny care.

Senators Push for Answers

In the weeks following The Guardian report, Senators Ron Wyden (D-OR) and Elizabeth Warren (D-MA) launched their own investigation of the insurance giant’s cost cutting measures in nursing homes. Wyden and Warren sent a letter to then UnitedHealth Group leaders requesting documents and information about the nursing home incentive program.

New Allegations

A new letter from Senators Wyden and Warren states that UHG has refused to comply with the initial request. In the months since the demand for information, UHG has provided only “brief and unsubstantial answers” to their questions.

“Because you have failed to respond adequately to our inquiry – and in light of additional recent reporting – we are renewing our inquiry with heightened alarm.”

Ron Wyden and Elizabeth Warren

United States Senators

Additional Reports

The Senators’s letter alludes to recent additional reports. They were referring to a December story, also from The Guardian, reporting allegations of wrongful deaths inside the nursing home care program. In a statement, UnitedHealth denied any allegations their practices “endanger patient safety or violate ethical standards.”

No Response is a Response

When asked about the second letter, UnitedHealth Group did not respond to reporters at The Guardian. UHG leadership said in statement that they would “continue to engage” with the senators. The company’s leadership also maintains that its nursing home program “improves outcomes” and “reduces unnecessary hospitalizations.”

Unanswered Questions

UnitedHealth attended a briefing with the senators’ offices last July. During that meeting, UnitedHealth made several claims the Senators are now questioning.

UHG maintained their nurses are not required to contact company representatives prior to taking a nursing home patient to the hospital, but a document provided by a whistleblower alleges the opposite
UHG failed to adequately explain why hospital admission rates are part of the metrics for determining bonuses
UHG chose not to respond to questions about pending wrongful death lawsuits for Mary Grant, Cindy Deal, and an unnamed nursing home resident in New York

Deadline to Comply

Senators Wyden and Warren allege that UnitedHealth Group has withheld internal documents that directly relate to their initial request for information. The senators gave a deadline of January 28, 2026 to respond with the following information:

Hospitalization policies, including clinical protocols for determining when transfers are warranted, definitions of avoidable versus unavoidable hospitalizations, and whether staff must consult Optum supervisors before hospital transfers.
Bonus program metrics and thresholds, including how UnitedHealth determines APK limits, whether facilities are penalized for exceeding thresholds, and five years of documentation on bonus payments to nursing homes.
Advance directive policies, including training materials for end-of-life conversations, the mortality risk assessment tool used, and who participates in those discussions with residents.
Marketing and enrollment practices for I-SNP plans at contracted nursing homes.
Federal oversight and compliance, including any CMS sanctions or enforcement actions in the past five years.

Wyden Warren UnitedHealth Group Heightened Alarm

Failure to Respond

Without adding details, the letter states that should UnitedHealth Group fail to respond it full, they will seek answers to their questions using “all tools at the Committee’s disposal.”

This is an ongoing inquiry/investigation and story. The Rowan Report will continue to provide updates as they become available.

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DOJ Settles with UnitedHealth and Amedisys

by Kristin Rowan | Aug 21, 2025 | Legal, M&A, Medicare, Medicare Advantage

by Kristin Rowan, Editor

DOJ Settles with UnitedHealth and Amedisys

Judge to Weigh In

DOJ settles with UnitedHealth and Amedisys after almost nine months of negotiations. The Department of Justice (DOJ) initially blocked the proposed merger between UnitedHealth and Amedisys, citing concerns over eliminating competition in home health and hospice services in some areas of the U.S. After the most recent settlement hearing, the merger seems to be back on track.

Public Comment Period and Judicial Review

Now that the DOJ hurdle has been passed, there is a public comment period. Following the public comment period, the U.S. District Court for the District of Maryland will enter final judgement. From the Justice Department website:

As required by the Tunney Act, the proposed settlement, along with a competitive impact statement, will be published in the Federal Register. Any interested person should submit written comments concerning the proposed settlement within 60 days following the publication to Jill Maguire, Acting Chief, Healthcare and Consumer Products Section, Antitrust Division, U.S. Department of Justice, 450 Fifth Street NW, Suite 4100, Washington, DC 20530.

Antitrust Division Statement

“In no sector of our economy is competition more important to Americans’ well-being than healthcare. This settlement protects quality and price competition for hundreds of thousands of vulnerable patients and wage competition for thousands of nurses. I commend the Antitrust Division’s Staff for doggedly investigating and prosecuting this case on behalf of seniors, hospice patients, nurses, and their families.”

Abigail Slater

Assistant Attorney General, Justice Department Antitrust Division

Divestiture Agreement

According to the new agreement, UnitedHealth will sell 164 home health and hospice locations across 19 states. In addition to the sale, the agreement provides the buyers of these locations with assets, personnel, and relationships to help them compete with remaining UnitedHealth locations. Also included are protections to deter UnitedHealth from interfering with the new owners’ ability to compete.

BrightSpring Health Services and Pennant Group will acquire the 164 locations. Slater said the settlement, which includes the largest ever divestiture of outpatient healthcare, protects quality and price competition patients as well as wage competition for nurses. However, antitrust specialist Robin Crauthers, a partner with McCarter & English, says it doesn’t go far enough. According to Crauthers, the settlement agreement does not address all of the markets that would have less competition and that the DOJ accepted less than they wanted in the agreement.

Additionally, critics argue the divestiture moves 164 home health and hospice agencies from one large player to two other large players in the space. Arguably, rather than preserve competition, this divestiture agreement will only serve to strengthen the largest players in the market, giving them a substantial advantage over smaller agencies in these areas.

UnitedHealth Amedisys divestiture locations

Not the Only Concern

Vertical Integration

Joe Widmar, Director of M&A at West Monroe consulting firm, says that the number of home health and hospice agencies is not the tipping factor in competition. Rather, it is UnitedHealth’s vertical integration. A health insurance company that also owns nearly 2,700 subsidiaries, including pharmacies, home health and hospice, behavioral health, consulting for healthcare organizations, surgery centers, hospitals, mental health, managed care for Medicaid and Medicare, and specialty care. Virtually any referral from a PCP to any other health professional puts more money into the health care giant’s pockets. The lack of competition is across all forms of healthcare, leaving patients no choice buy to support UnitedHealth Group in areas where all local healthcare providers are subsidiaries. I 2024, UnitedHealth insurance paid $150.9 million to its subsidiaries for care. These provider companies are not counted in the profit caps placed on insurance companies.

Upcoding

In addition to side-stepping profit caps, vertical integration aids in upcoding. Upcoding is the practice of digging into a patient’s life to find (or create) additional patient needs. Insurers add as many codes as possible for the greatest reimbursement rates. According to a recent study, UnitedHealthcare overbilled Medicare Advantage by $14 billion through upcoding.

In-home health risk assessments and patient reviews, often offered to beneficiaries as a free service, result in an average risk score 7% higher than in patients seen in medical practices and hospitals. UnitedHealth generates more income from patient review diagnoses than any other MA insurer. The Department of Justice is currently investigating UnitedHealth’s Medicare billing practices.

Final Thoughts

If you own a home health, hospice, or palliative care agency in any of the states shown in the graphic above, write to Jill Maguire with comments and concerns. Our primary objective is providing quality care to patients in their homes. We know that home care is less expensive for the patient and government-funded insurance. But not when all the home care agencies in an area are owned by only a few of the largest home health agencies in the country. And not when the insurer is adding diagnostic codes to pad their bill.

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Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news, and speaker on Artificial Intelligence and Lone Worker Safety and state and national conferences.

She also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2025 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

UnitedHealth Bribes Nurses

by Kristin Rowan | Jun 13, 2025 | Medicaid, Medicare, Medicare Advantage, Other Sites, Regulatory

United Health Bribery Update

In the weeks since the below article revealed allegations against UnitedHealth, members of Congress are calling for action. At least one US Senator and two Representatives are engaged in the allegations. Senator Wyden (D-OR) announced that his office is launching its own investigation. Senator Hawley (R-MO), who is on the investigations subcommittee said it was “alarming to hear these serious allegations. I look forward to securing justice for patients, policyholders, and whistleblowers alike who’ve been harmed by insurance companies.” Other Senators expressed similar sentiments.

“If these allegations are true, UnitedHealth must be held responsible for their gross abuse of patients. Patients should always come before profits.”

Buddy Carter

Chair of the House subcommittee on health, U.S. Representative, (R-GA)

Three U.S. Representatives, coming from both sides of the aisle, are calling on the DoJ to investigate. A letter to the DoJ reads:

“The Guardian’s findings reveal the need for a wide-ranging investigation by the Department of Justice into years, if not decades, of potential waste, fraud, and abuse at UnitedHealth.”

Here is another take on the breaking news story, published by whistlebloweraid.org

The Guardian has uncovered some truly disturbing information about UnitedHealth Group. As the investigation and reporting belongs to them, I have reprinted the first part of the article here. Read the full article here.

by George Joseph, The Guardian
Wed May 21, 2025

Revealed: UnitedHealth secretly paid nursing homes to reduce hospital transfers

A Guardian investigation finds insurer quietly paid facilities that helped it gain Medicare enrollees and reduce hospitalizations. Whistleblowers allege harm to residents

UnitedHealth Group, the nation’s largest healthcare conglomerate, has secretly paid nursing homes thousands in bonuses to help slash hospital transfers for ailing residents – part of a series of cost-cutting tactics that has saved the company millions, but at times risked residents’ health, a Guardian investigation has found.

Those secret bonuses have been paid out as part of a UnitedHealth program that stations the company’s own medical teams in nursing homes and pushes them to cut care expenses for residents covered by the insurance giant.

In several cases identified by the Guardian, nursing home residents who needed immediate hospital care under the program failed to receive it, after interventions from UnitedHealth staffers. At least one lived with permanent brain damage following his delayed transfer, according to a confidential nursing home incident log, recordings and photo evidence.

“No one is truly investigating when a patient suffers harm. Absolutely no one,” said one current UnitedHealth nurse practitioner who recently filed a congressional complaint about the nursing home program. “These incidents are hidden, downplayed and minimized. The sense is: ‘Well, they’re medically frail, and no one lives for ever.’”

Confidential Investigation

The Guardian’s investigation is based on thousands of confidential corporate and patient records obtained through sources, public records requests and court files, interviews with more than 20 current and former UnitedHealth and nursing home employees, and two whistleblower declarations submitted to Congress this month through the non-profit legal group Whistleblower Aid.

The documents and sources provide a never-before-seen window into the company’s successful effort to insert itself into the day-to-day operations of nearly 2,000 nursing homes in small towns and urban commercial strips across the nation – an approach which has helped UnitedHealth secure a vast stream of federal dollars from Medicare Advantage plans that cover more than 55,000 long-term nursing home residents.

UnitedHealth Responds

UnitedHealth said the suggestion that its employees have prevented hospital transfers “is verifiably false”. It said its bonus payments to nursing homes help prevent unnecessary hospitalizations that are costly and dangerous to patients and that its partnerships with nursing homes improve health outcomes.

Long-Term Profit

Under Medicare Advantage, insurers collect lump sums from the federal government to cover seniors’ care. But the less insurers spend on care, the more they have for potential profit – an opportunity that UnitedHealth higher-ups have systematically sought to exploit when it comes to long-term nursing home residents.

To reduce residents’ hospital visits, UnitedHealth has offered nursing homes an array of financial sweeteners that sounded more like they came from stockbrokers than medical professionals.

Seven Years of Bribery and Threats

Over the past seven years, the company has shelled out “Premium Dividend” and “Shared Savings” payments that boosted nursing homes’ bottom lines. Through its “Quality and Shared Risk” program, UnitedHealth offered an even bigger cut to nursing homes that drove down medical spending, but threatened to claw back money from those that didn’t, according to former employees and internal corporate documents.

“You gain profitability by denying care, and when profitability suffers for the shareholders, that’s when people get crazy and do things that are not appropriate.”

Anonymous

Former National Executive, United Health

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BREAKING NEWS: UnitedHealth CEO Steps Down

by Kristin Rowan | May 16, 2025 | Breaking News

by Kristin Rowan, Editor

Breaking News: UnitedHealth Group CEO Andrew Witty Steps Down

Citing “personal reasons” with no elaboration, UnitedHealth Group CEO Andrew Witty steps down from his position, effective immediately. Witty joined UnitedHealth Group in 2018 and became the company’s CEO in 2021. Despite overwhelming growth during Witty’s tenure, the company continues to face numerous setbacks.

UnitedHealth Group Struggles Since January

The shooting death of Brian Thompson, UnitedHealthcare CEO, in December seems to have set off an onslaught of setbacks for the insurance giant.

Share prices have dropped 38% since December, from $503 down to $308
The company recently cut its annual forecast, after first adjusting it down, causing the final 18% stock drop
For the first time since 2008, UHG missed its forecasted earnings
Statements from the company look to 2026 before growth resumes

New (Old) CEO

Stephen Hemsley is the new CEO of UnitedHealth Group, effective immediately. Hemsley, who currently serves as the director of the board, was the company’s CEO from 2006 to 2017. Hemsley will stay on as chairman of the board and company CEO. Witty will serve as senior adviser to Hemsley.

Contradictions and Conflicts

In an official statement regarding the leadership change, Hemsley said, “We are grateful for Andrew’s stewardship of UnitedHealth Group…. The Board and I have greatly valued his leadership and compassion as chief executive….”

On a call with investors, Hemsley said, “Many of the issues standing in the way of achieving our goals as well as our opportunities are largely within our control.”

During that same call, Hemsley said, “I’m deeply disappointed in and apologize for the performance setbacks we have encountered from both external and internal challenges.”

In addition to the conflicting statements, Hemsley will serve as CEO and Chairman of the Board, creating conflict and reducing oversight. The chairman of the board plays a key role in oversight, governance, and communication with the CEO. They also evaluate the CEO’s performance. Holding both roles, especially in light of the shareholder request for reports, may we be in the best interest of UnitedHealth Group, but probably not in the best interest of anyone else.

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New Deal to Sell HH & Hospice Agencies

by Kristin Rowan | May 9, 2025 | M&A

by Kristin Rowan, Editor

UnitedHealth, Amedisys to Divest Home Health & Hospice...Again

History

UnitedHealth, Amedisys to divest home health and hospice properties to satisfy DOJ. Almost two years ago, the health services division of UnitedHealth Group, Optum, announced plans to by Amedisys. The purchase announcement came after Optum outbid Option Care Health with an unsolicited offer. The Department of Justice launched an anti-trust probe shortly after the announcement. To satisfy the DOJ, UnitedHealth and Amedisys plan to divest some of its businesses as part of the acquisition agreement.

Anti Anti-Trust

We previously reported that Amedisys entered into an agreement with VitalCaring to divest some of its home health and hospice locations. This agreement was meant to satisfy the DOJ concerns raised in its anti-trust lawsuit against Amedisys and UnitedHealth.

In January of 2025, VitalCaring lost a lawsuit filed by Encompass Health and Enhabit and were ordered to pay 43% of all future profits to the two companies. In the wake of that court decision, VitalCaring pulled the agreement and signed a mutual release with UnitedHealth, with all parties walking away from the deal.

BrightSpring

BrightSpring Health Services is an $11.5B company with locations across the United States and employing more than 37,000 people. In January of this year, BrightSpring sold is Community Living Business to Sevita. BrightSprings intends to acquire additional properties, focusing on its home- and community-based businesses. According to the BrightSpring President and CEO Jon Rousseau, BrightSpring is “focused on getting to 3x leverage within the next two years.”

Amedisys operates in 38 states with more than 500 locations. The document Amedisys submitted to the SEC does not indicate how many of its properties and those of UnitedHealth will be divested. A UnitedHealth statement said the company plans to divest at least 128 home health and hospice facilities.

One has to wonder whether we are trading one monopoly for another.

New Deal

As the DOJ lawsuit enters mediation this August, UnitedHealth and Amedisys search for another way to divest its properties. Enter the New Deal. BrightSpring Health Services, parent company to Adoration Home Health Acquisition LLC, Adoration Hospice Care Acquisitions LLC and Senescence LLC, DBA All Saints Hospice will purchase some of the properties from both Amedisys and UnitedHealth. The Pennant Group, parent company to Cornerstone Healthcare, Inc. and Tensaw River Healthcare, LLC, will purchase additional properties from bother companies.

According to documents submitted to the Securities and Exchange Commission (SEC), both agreements have mulitple contingencies, including the finalization of the UnitedHealth/Amedisys merger. Financial information on the two deals was not included in the Amedisys SEC filing. In a separate filing, Pennant valued their part of the agreement at nearly $102.5 million.

No Deal Yet

The sale of properties to BrightSpring and Pennant Group relies on the finalization of the merger between Amedisys and UnitedHealth. A magistrate will oversee mediation between the two companies and the DOJ beginning this August.

The SEC and the DOJ have not yet responded to the intent to divest to BrightSpring and Pennant Group.

Final Thoughts

The proposed merger between UnitedHealth and Amedisys has been ongoing for two years. The two companies, who previously stated their competition helped keep them honest and keep costs low, now state that the merger will lower costs even more. The DOJ disagrees. To alleviate concerns, the merger includes the release of properties anywhere the merger would create an unfair advantage. Mediation in August will reveal more on the position of the DOJ, the response from UnitedHealth and Amedisys, and the specifics of the divestment of home health and hospice agencies. The merger proposal expires December 31, 2025. We will continue to follow the story as the parties enter mediation.

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Trouble in MA Paradise?

by Kristin Rowan | May 1, 2025 | Advocacy, CMS, Editorial, Medicaid, Medicare, Medicare Advantage

by Kristin Rowan, Editor

Medicare Advantage

It’s no secret within the care at home community that Medicare Advantage is not without its problems. Coverage and care are good when the beneficiary is relatively healthy. When it’s really needed, MA plans deny coverage. Multiple insurance companies have upcoded patient care for higher reimbursements. And predatory marketing tactics target our most vulnerable.

Predatory Marketing

Medicare Advantage payers use unethical marketing to target seniors, sometimes going as far as to call unwitting customers and strong-arm them into changing from their traditional Medicare plans to MA. Anecdotally, a family friend was convinced to switch to Medicare Advantage three times. Each time, his family caregiver reversed that change before any real damage was done. Similarly, our own Editor Emeritus, Tim Rowan, fielded calls aimed at his disabled, grieving brother, urging him to change to a MA plan. Luckily, those calls were deflected by someone who knew better. Not everyone is as lucky.

UHC Projects Lower Earnings

Despite a 9.8 billion dollar year-over-year increase in revenue in the first quarter of 2025, UnitedHealth Group last week submitted a lower earnings outlook for 2025. UHG attributed the revision to “increased care activity” in its Medicare Advantage business.

UHG has strong growth in providing benefits and services to more members. In Massachusetts, for example, the company reported 100% growth in care activity. Simultaneously, Optum Health, the arm responsible for home health, took on more clients with lower reimbursement rates, impacting overall revenue. Optum cites changes to the CMS risk adjustment model particularly for complex patients as a contributor to the problem.

Breaking it Down

UHG initially projected strong growth through 2025. The projection was partly based on the expection of a gradual increase in care activity. More members should increase revenue. What UHG did not account for was rapid growth of high-risk members in a risk-adjustment model that had not yet been thoroughly tested. Medicare Advantage is a money losing model that is propped up by Traditional Medicare. UHG is finally feeling that impact and it will only get worse as HHS cracks down on waste, fraud, and abuse in MA.

Elevance Pulls Plug on MA Marketing

One week after UHG revised its earnings projections for 2025, Elevance announced plans to cut is Medicare Advantage marketing. EVP of payer solutions at ATI Advisory, a consulting firm in the healthcare space, says cutting spending on MA marketing happens for different reasons.

“It’s often a temporary decision to give an MAO a year to ‘catch up’ or right-size impacts from the prior year. For example, it might be in response to larger-than-expected enrollment during the prior year, higher-than-expected utilization the plan is trying to get under control, or a change in federal policy.”

Breaking it Down

Elevance reported better earnings in Q1 2025 than were expected. The company listed home health as one of its key revenue drivers. The operating revenue increase came from higher premiums and growth in MA membership. The announcement to cut marketing spend came less than a week later.

In other words, the company had a surge of MA sign-ups at the beginning of the year when plan coverage started after open-enrollment. Now that the company is seeing how many of those members actually need care and how much they will have to spend to provide that care, they no longer want to enroll additional MA members.

Opposition

The National Association of Benefits and Insurance Professionals expressed “deep concern” over Elevance’s announcement. NABIP represents licensed health insurance agents and brokers with a stated goal of promoting access to affordable health insurance coverage.

“This decision directly harms Medicare beneficiaries by limiting their access to essential healthcare options and support during Medicare’s enrollment period,” NABIP CEO Jessica Brooks-Woods said.

NABIP asked CMS, Congress, and health plans to mitigate the effects of this announcement. They urged CMS to “freeze any carrier-initiated changes after October 1 that would limit agent access.

Breaking it Down

NABIP represents agents and brokers who sell insurance plans to eligible members. They are membership based and rely on member fees as a main revenue stream along with fees collected for education, advertising, and sponsorships. Their PAC raises money from members to support political candidates.

Agents and brokers make money from commissions on sales of healthcare plans. The commission on Medicare Part D is around $109 per member per year. The commission on Medicare Advantage plans varies by state and carrier, but is as high as $780 per member per year. Commissions for Medicare Supplement plans are a percentage of premiums. The average commission for supplement plans is $322.

But, of Course...

It is not surprising, then, that the member-based advocacy group on behalf of sales people who earn nearly 7 times the commission on MA plans wouldn’t want companies like Elevance to stop marketing them.

Final Thoughts

I don’t believe Medicare Advantage is going anywhere anytime soon. I also don’t believe any government agency can monitor itself for fraud, waste, and abuse. Further, I don’t believe an association that makes its living on commissions has the best interest of its customers as its first priority.

Perhaps fewer beneficiaries will be subjected to the predatory marketing and sales calls pushing them into Medicare Advantage plans. Perhaps knowledgeable, well-intentioned individuals and associations can shed light on the real advantages of Traditional Medicare. Perhaps CMS, under the direction of HHS, will turn the “waste, fraud, and abuse” mirror in the direction it belongs.

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Prior Authorization Requirement Removed by UnitedHealthcare

by Kristin Rowan | Mar 7, 2025 | Clinical, CMS, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

Easier Access to Home Health

Prior authorization requirements can be cumbersome, delaying or even preventing care in some cases. Patients who need prior authorization to get he care they need also generally have form after form to fill out or to have completed by their PCP or hospital physician, who doesn’t have time for adequate visits, much less more paperwork.

As part of their ongoing efforts to reduce prior authorization volume by 10%, UnitedHealthcare has just announced a change in their home health services requirements.

Limits on Where Changes Apply

Beginning April 1, 2025, UHC will no longer require prior authorization or concurrent reviews for home health services managed by Home & Community (formerly naviHealth). This is the next step in an ongoing effort to modernize the authorization process and simplify health care for its members and providers.

These changes will apply to Medicare Advantage and Dual Special Needs Plan (D-SNP) beneficiaries in 36 states and the District of Columbia.

Alabama
Alaska
Arkansas
California
Colorado
Connecticut
Florida*
Georgia
Idaho
Illinois
Indiana
Iowa
Kansas

Kentucky
Louisiana
Maine
Maryland
Massachusetts
Nebraska
Nevada
New Mexico
North Carolina
North Dakota
Ohio
Oklahoma
Oregon

Pennsylvania
Rhode Island
South Carolina
Tennessee*
Texas
Utah
Virginia
Washington
Wisconsin
Wyoming
Washington, D.C.

*In Florida and Tennessee, the changes will not apply to D-SNP plans that are not managed by Home & Community.

Prior Authorization Additional Information

You should continue to request prior authorization and concurrent review through March 31, 2025. UHC reminds all providers that following CMS guidelines for providing home health care services is still required. And in states where a Medicare denial is required to get Medicaid prior authorizations, providers should submit their requests through the UHC provider portal.

The available information on this pending change is limited. We will provide updates should they become available. Please contact UHC directly through the provider portal if you have specific questions.

# # #

Kristin Rowan has been working at The Rowan Report since 2008. She is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news .She also has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

VitalCaring Pulls Agreement

by Kristin Rowan | Jan 9, 2025 | Breaking News, Regulatory

by Kristin Rowan, Editor

Just as we were setting the article on UnitedHealth Group and Amedisys for publication, we received the following breaking news story:

VitalCaring Divestment Agreement Cancelled

VitalCaring entered into the agreement on June 28, 2024, just after the merger announcement and initial pushback from the Department of Justice. The DOJ approved the divestiture, despite some misgivings about the quality of care. VitalCaring said at the time that it believed the merger and the divestment were in the “best interest of patients and stakeholders.”

VitalCaring has been under its own scrutiny since 2022 when Encompass Health and its home health and hospice arm, Enhabit, Inc. accused VitalCaring CEO April Anthony of using unethical practices to establish the company. Anthony is the founder of Encompass Home Health & Hospice, the previous owner and CEO of Liberty Health Services, and founder and former CEO of Homecare Homebase.

She Who Shall Not be Named

Encompass Health filed an injunction against April Anthony, and her partners Vistria Group and Nautic Partners in 2021 for violation of the terms of her employment agreement, non-competition agreement, non-solicitation, and misappropriation of trade secrets.

Anthony and her partners purchased a small home health agency in Louisiana and started plan for its growth while Anthony was still CEO of Encompass. Additionally, Anthony recruited employees of Encompass to work at her new venture using a fake recruiter to cover her tracks. Anthony used fake names, spouses’ phones, and her personal laptop to remain undetected during this time. Anthony asked her partners and recruits to refer to her as Voldemort.

Judgment Day

In August of 2022, a judge called the actions of Anthony and her partners “willful misconduct” and agreed with almost all of Encompass’s allegations. The judge found that Anthony was in violation of her non-compete agreement and that she was actively running a direct competitor while still serving as CEO of Encompass. The judge stated, “These are not the actions of a person complying with her contractual obligations.” Although Encompass’s injunction asked to have the non-compete agreement extended, the judge only enforced the existing non-compete agreement, and found that that Anthony had violated the covenant.

Pay the Piper

The Delaware Court of Chancery, in December of 2024, agreed with the earlier findings of the court and found that Anthony, two former senior officers of Encompass, and the investment companies were complicit in their miconduct and that VitalCaring was a result of their deceit.

The court awarded an upfront payment for mitigation damages of $1.62 million dollars plus attorneys’ fees. The court also imposed a trust entitling Encompass Health and Enhabit to 43% of al of VitalCaring Group’s future profits, paid quarterly as well as 43% of proceeds if and when the company is sold.

Divorce Proceedings

Depending on the source, each of the companies involved in the divestiture agreement are claiming credit for filing for divorce.

An equity analyst for UnitedHealth Group said, “UNH has abandoned VitalCaring as a divestiture buyer after the Delaware Chancery decision against VitalCaring’s executives.”
An article from a hospice website stated, “Amedisys has halted the divestiture of some of its home health and hospice locations to Texas-based VitalCaring.
A stock market website reported “VitalCaring Group cancelled the acquisition of certain home health care centers from UnitedHealth Group, Inc.”

Regardless of who filed for divorce, UnitedHealth Group and Amedisys are courting new partners to acquire the home health centers that need to be divested before their marriage can be blessed by the DOJ.

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UnitedHealth Group Amedisys Merger Faces Further Delays

by Kristin Rowan | Jan 9, 2025 | M&A, Regulatory

by Kristin Rowan, Editor

UHG and Amedisys Waive Termination

The UnitedHealth Group and Amedisys merger has been an ongoing story since the initial merger agreement was signed in June of 2023. The proposed merger came under scrutiny by the Federal Trade Commission (FTC) and the Department of Justice (DOJ). UnitedHealth Group and Amedisys are competitors in the home healthcare market and the merger would hurt patients.

“UnitedHealth’s plan to extinguish Amedisys as a competitor is the result of an intentional, sustained strategy of acquiring, rather than beating, competition.”

Department of Justice

DOJ Pushes Back

Late in 2024, the DOJ filed a lawsuit against the merger, claiming that both companies have acknowledged that their competition helps keep them honest and drive quality both in patient and employee care. The DOJ noted that the acquisition would be presumptively illegal in multiple markets. UHG, Amedisys, and Optum proposed selling off some of its care centers to address the concerns about competition.

Merger Deadline Reached

Under the initial merger agreement, UHG would pay $3.3 billion to acquire Amedisys, which would remain as a subsidiary of UHG. That agreement was set to be finalized on December 27, 2024. There has been no decision made on the DOJ lawsuit, so the merger could not be completed. UHG and Amedisys have mutually agreed to extend the merger and added a break fee of $275 million.

Indefinite Merger Extension Through 2025

The new agreement has an indefinite ending. According to the wording, the merger agreement will now expire either on December 31, 2025 or 10 days after a final court decision in the lawsuit, whichever comes first.

According to the new filing with the SEC, UnitedHealth and Amedisys will be divesting assets to secure the merger and satisfy the DOJ. If not, they will incur a break fee of up to $325 million. Both companies have an agreement with VitalCaring Group to acquire the necessary assets.

What If?

If…The Trump administration is less stringent in antitrust matters, as expected.

The lawsuits currently at the U.S. District Court and five states will likely fail.

If…the U.S. District Court for the District of Maryland either decides to block the merger permanently or does not reach a final order by the end of the year…

The merger agreement will expire.

If…UnitedHealth Group, Optum, and/or Amedisys fails to divest holdings…

The merger agreement will not satisfy the antitrust regulations and the failing party will pay hundreds of millions in damages, and the merger agreement will end.

This is an ongoing story and we will continue to report on updates as they occur. See our accompanying BREAKING NEWS story.

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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

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