The healthcare juggernaut’s latest review found minor issues with how UnitedHealthcare develops medical policies, which inform whether care is approved or denied. But the audit has gaps.

UnitedHealth on Thursday released the results of the latest audit of its business practices, part of CEO Stephen Hemsley’s commitment to improving the healthcare juggernaut’s transparency and relationship with the public.

The review focused on how UnitedHealth’s insurance unit UnitedHealthcare creates clinical criteria used to make coverage decisions. It found few faults with the process.

But the review left out a key element — how the policies are actually being applied, a question with major ramifications for the more than 48 million people in the company’s insurance plans who could have their care approved or denied as a result.

It’s also a major area of scrutiny for lawmakers and regulators concerned that UnitedHealthcare’s coverage decisions could be based on profit motives rather than medical necessity. Research has shown that many of the Minnesota-based insurer’s coverage denials are overturned upon appeal, suggesting the care should have been approved in the first place and may have been rejected to save UnitedHealthcare money.

A UnitedHealth spokesperson did not comment on why the application of medical criteria was left out of the audit, and whether it could be covered in a future review.

“This review was designed to answer a specific question if UnitedHealthcare develops, maintains and oversees its medical policies with rigor and in line with external standards and clinical evidence,” the spokesperson said.

The audit dug into the expertise and processes of the more than 80-person team that crafts UnitedHealthcare’s medical policies, which include criteria used to decide if a treatment, drug or device should be used for a particular member’s care.

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