By Amina Niasse
NEW YORK, July 7 (Reuters) – UnitedHealth on Tuesday said an audit by an external consulting firm showed nearly 97% of diagnoses identified within its HouseCalls home-health unit, which has faced scrutiny from lawmakers, were supported by a patient’s medical record.
“We look at this with both a sense of pride, but also humility,” said Wyatt Decker, an executive vice president at UnitedHealth, adding the company aims to make sure that documentation practices by nurse practitioners more accurately reflect diagnoses patients receive.
According to the Wall Street Journal, the Department of Health and Human Services has scrutinized diagnoses that appear only in UnitedHealth’s home-visit assessments and do not appear elsewhere in a patient’s medical record. Patient diagnoses submitted by HouseCalls help determine Medicare Advantage payments to the company’s insurance arm, UnitedHealthcare.
The report said 3.4% of diagnoses made by HouseCalls clinicians in 2025 were not supported. HouseCalls, a home-healthcare program under UnitedHealth’s Optum primary care business, sends clinicians annually to perform physical exams and discuss patients’ medical history. UnitedHealthcare operates Medicare Advantage plans for adults 65 and older and people with disabilities on behalf of the government.
CEO Stephen Hemsley in a letter to stakeholders said the company was committed to doing better and believed home visits helped seniors avoid more expensive medical emergencies.
Hemsley promised the review of the company’s businesses last year after UnitedHealth missed its own profit expectations for the first time since 2008. UnitedHealth commissioned business consulting firm FTI Consulting to conduct the analysis.
FTI in a previous report found that UnitedHealth sometimes lacked standardized documentation in its HouseCalls program.
FTI’s report analyzed 200 visits, representing 494 diagnoses. The new report has not yet resulted in changes to the company’s policies, Decker said.
(Reporting by Amina Niasse; Editing by Stephen Coates)
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