Internet comments heaped scorn Thursday on UnitedHealthcare as the Minnetonka-based health insurer mourned the killing of its chief executive, Brian Thompson, who was shot just before an investor conference where the company was to reveal plans for greater profits next year.
Police have not publicly speculated on the motives of the person who shot at Thompson at least three times at close range Wednesday on a Manhattan sidewalk. But the sense that the shooting could be related to Thompson’s job and UnitedHealthcare’s reputation for denying care grew when it was revealed that one bullet casing found at the scene reportedly had the word “deny” written on it.
UnitedHealthcare is a for-profit company, but it’s not proven whether it’s really more aggressive than other insurers at denying care or simply that it draws more attention as the nation’s largest health insurer. Public data sets on denial rates by insurance companies are limited. But the shocking shooting has put new focus on the firm, its reputation and history.
While the insurer grew into one of Minnesota’s largest employers and economic engines, the state declined for decades to license it or any other for-profit company to sell HMO plans. That prohibition was lifted in 2017 when Republican lawmakers sought to expand insurance options for Minnesotans, but Democratic lawmakers in 2024 specifically prohibited for-profit HMOs such as UnitedHealth from selling plans in the state’s growing Medical Assistance program.
“Let’s face it: For-profit companies exist to legally maximize shareholder value,” said Rep. Liz Reyer, DFL-Eagan, earlier this year when a court decision upheld Minnesota’s for-profit prohibition. “That’s their requirement.”
The company has faced increasing public scrutiny and congressional inquiries over its denials of care, especially to elderly participants in Medicare Advantage plans. A report by a U.S. Senate subcommittee last October scolded UnitedHealthcare for denying prior authorization requests for expensive post-acute care at three times the rate that it denied other requests. UnitedHealthcare in response said it still approves the vast majority of requests for post-acute care for patients after hospitalizations, and that it is federally required to give these claims heightened scrutiny. The company also has been accused of relying on a claims process, supported by artificial intelligence, that had a 90% error rate in determining whether a requested treatment was medically necessary.
UnitedHealthcare announced as recently as March 2023 that it was dialing back some requirements for prior authorizations, but the publicly traded company is always going to face opposing pressures, said Wendell Potter, a former Cigna vice president who has since become a whistleblower on the industry’s practices. An increase in spending on patients’ care caused the stock of UnitedHealthcare’s parent company to drop as much as 8% this fall, putting it under pressure from investors and analysts.
“It’s a company that has been a Wall Street darling,” Potter said, “and the way you become a Wall Street darling is you do a really good job of managing medical expense. It means you need to employ things like prior authorization and do it aggressively.”