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UnitedHealth releases independent audit of its medical policy development practices

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UnitedHealth releases independent audit of its medical policy development practices

Over the past year, UnitedHealth Group has conducted a series of independent reviews of its practices as part of a broader turnaround effort at the company.

The healthcare giant released the last of these analyses on Thursday, digging into the processes it uses to establish medical policies. The reviews were conducted by FTI Consulting and Rubrum Advising, a provider-led firm with expertise in medical coverage policies.

While the auditors dove into the processes the insurer uses to develop its medical policies, the report doesn't examine the application of those polices and any impact on coverage denials, an area where UnitedHealthcare has drawn significant public scrutiny.

The report concluded the company's methods "were strong overall and that the medical policy development process reflected numerous best practices."

For instance, UnitedHealthcare's Medical Policy team uses a structured and standardized process to establish medical policies, rooted in evidence-based and stakeholder-informed approaches. Clinical evidence comes from nationally recognized authorities, and epidemiologists play a key role in the review process, per the report.

In addition, the analysts concluded that the team is well-staffed with qualified workers and operates under a strong governance model. Medical policies are built "using systematic evidence review, evidence-based tools and industry best practices," and UnitedHealthcare is transparent about posting these policies and making updates.

All policies are reviewed at least once per year, the report found.

CEO Stephen Hemsley said in a letter to investors that the company will continue to conduct such analyses.

"We will continue to subject key practices across UnitedHealth Group to independent review, share results publicly and make changes where needed," Hemsley wrote.


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