A new study has intensified scrutiny of UnitedHealth Group’s vertical integration strategy, alleging that UnitedHealthcare pays its sister company, Optum, 17% more than non-Optum providers — and as much as 61% more in markets where UnitedHealthcare holds major market share.
Researchers from Brown University and UC Berkeley say the findings suggest UnitedHealth may be circumventing federal “medical loss ratio” (MLR) rules, which require insurers to spend most premium dollars on patient care rather than profit. By paying its own providers through Optum, the study argues, UnitedHealth can effectively recycle premiums internally, reporting them as care expenses while boosting corporate revenue.
UnitedHealth forcefully rejected the claims, saying the analysis “cherry-picks data” and is “flat-out wrong.”