To our valued stakeholders:
At UnitedHealth Group we are committed to better health and a higher standard of care. That means taking a hard look at our core business practices to understand what is working and where we can do better and, importantly, being transparent in sharing the actions we are taking to meaningfully improve patient and provider experiences.
In that spirit, I want to provide an update since we published the findings of our first set of independent reviews and corresponding action plans in December 2025 and share the initial results of an examination of our diagnosis coding practices in our HouseCalls program.
In their reports, two sets of third-party assessors determined our policies and practices to risk assessment, managed care practices and pharmacy benefits are robust, rigorous and, in many respects, industry leading. They also provided 23 specific recommendations to strengthen consistency, governance and coordination.
Today, I am pleased to report we have implemented all 23 improvements.
Read more about those 23 improvements here.
Through our HouseCalls program, we provide comprehensive, clinician led medical visits in seniors’ homes—similar to an annual physical—helping identify health issues, care gaps, safety risks, behavioral health needs and social barriers often missed in office care.
We view care in a patient’s home as one part of a broader, integrated value-based care model helping seniors engage earlier and avoid costly emergency care. By reaching people with access or mobility challenges and connecting them to ongoing primary care, our home visits are linked to up to 5% fewer inpatient stays and 4% fewer ER visits for seniors with conditions like diabetes, heart disease, hypertension or depression in the year after a visit. These visits make up a small but meaningful share of the more than 19 million home visits UnitedHealth Group clinicians make each year.
UHG clinicians coordinate with primary care providers before, during and after each home visit to ensure continuity. During a home visit, licensed clinicians confirm and document diagnoses based on a full medical exam—not self reported questionnaires. Information from those visit diagnoses is also shared with the member’s primary care provider to support follow up care and keep the care plan up to date. About 75% of seniors have a follow-up medical appointment within 90 days of these visits.
To validate the accuracy of the diagnoses coding from these visits, we engaged FTI Consulting to conduct an independent review and assess whether the diagnoses submitted to CMS were supported by the medical record.
FTI reviewed a random sample of 200 HouseCalls visits representing 494 diagnoses, using the same sampling methodology used by independent government reviewers. Overall, FTI found 99 percent of sampled diagnoses were supported by medical records or reflected in paid claims.
In its first-pass review, FTI found that nearly 97% of diagnoses were supported by the medical record.
The resulting 3.4% rate of unsupported diagnoses is nearly three times lower than the error rate CMS reported for its most recent industry audit of Medicare Advantage medical record reviews and lower than the 5% coding-variation threshold CMS uses in RADV-related audits.
After receiving FTI’s initial findings, our company reviewed the 17 diagnoses FTI could not initially validate based solely on the HouseCalls record and found support for most in the patient’s care history, including paid claims.
In a second-pass review, FTI found confirmation for 12 of the 17 diagnoses after reviewing medical records and paid claims.
Taken together, these results validate the integrity of the HouseCalls program, but we will continue to strive to ensure that only appropriately supported diagnoses are submitted to CMS.
While these are meaningful results, we are committed to doing better.
We established a Care Connectors team that manages follow up needs. When a clinician identifies a new or worsening condition during a home visit, they connect the person to a Care Connector before leaving the home to schedule follow up care, help find providers, answer questions and link to community resources. Care Connectors remain engaged after the visit to track follow up and ensure members get the care they need without navigating the system alone.
Together, these steps reflect our commitment to keep evolving home visits so they better meet seniors’ changing needs and help them stay connected to the care and support they rely on.
Read more about the review here.
We will continue to subject key practices at UHG to independent review, share the results publicly, and incorporate changes where needed so we can better serve the people who count on us.
In the coming weeks, we will report on our processes to craft evidence-based medical policy.
As we have said many times before, these reviews represent just one aspect of a broader commitment to a new standard of transparency and continuous improvement, ensuring our processes are clear and consistent and deliver the high-quality experiences and outcomes our stakeholders should expect from us.
I remain grateful for our colleagues who show up every day – in homes and in the office -- committed to serving the people who count on us. Their work is what makes healthier lives possible.
Sincerely,
Steve Hemsley
CEO, UnitedHealth Group