DOJ Investigating UnitedHealth for Antitrust Behavior 

By Consumers for Quality Care, on March 20, 2024

The Department of Justice (DOJ) is investigating UnitedHealth for alleged antitrust violations, according to The Wall Street Journal and Healthcare Dive.

Not only is UnitedHealth the largest private health care insurer in the country, but it also oversees a large network of doctor groups, one of the largest pharmacy benefit managers (PBMs), and its own billing and data analytics business. The DOJ stated that they are most concerned about UnitedHealth’s vertical consolidation as the company continues to acquire multiple sectors of the health care system operating as one behemoth.

For example, Optum, UnitedHealth’s health service subsidiary, has been acquiring physician practices for years. Regulators are concerned that UnitedHealth is manipulating consumer choice by directing them to visit physician sites they own, keeping services in-house and stifling competition in the process.

The DOJ is also investigating whether UnitedHealth engages in “upcoding,” the practice of insurers exaggerating consumers’ illnesses for increased government reimbursement, as well as exploiting loopholes that could allow them to pocket more of a consumer’s premium than what is otherwise allowed.

Decreased competition hurts consumers, often leading to fewer options for care and higher out-of-pocket costs. CQC urges regulators and lawmakers to scrutinize vertical consolidation in the health care system and work to ensure that consumers don’t foot the bill for anti-competitive practices.