UnitedHealth Group Inc. is a diversified managed health care company headquartered in Minnetonka, Minnesota, U.S. It is No. 14 on Fortune magazine's top 500 companies in the United States. UnitedHealth Group offers a spectrum of products and services through two operating businesses: UnitedHealthcare and Optum. Through its family of subsidiaries and divisions, UnitedHealth Group serves approximately 70 million individuals nationwide. In 2011, the company posted a net earnings of $5.142 billion.UnitedHealth Group is the parent of UnitedHealthcare, the largest single health carrier in the United States. It was created in 1977, as UnitedHealthCare Corporation , but traces its origin to a firm it acquired in 1977, Charter Med Incorporated, which was founded in 1974. In 1979, it introduced the first network-based health plan for seniors. In 1984, it became a publicly traded company.In 2011, J.D. Power and Associates gave UnitedHealthcare the highest employer satisfaction rating for self-insured health plans. UnitedHealthcare also received high marks from the American Medical Association in its 2011 National Health Insurance Report Card. The fourth annual report card evaluated seven national health insurance companies on the timeliness and accuracy of their claims processing based on a variety of payment, approval and process metrics. UnitedHealthcare moved into the top spot among its industry peers on two metrics: Contracted Fee Schedule Match Rate, which indicates how often an insurer's claim payment matches the contracted fee schedule; and Electronic Remittance Advice Accuracy, which measures the rate at which the insurer's allowed amount equals the physician practice's expected allowed amount. In a 2010 insurance industry publication, Business Insurance , UnitedHealthcare was named "Readers Choice" winner in 2010 for "Best health plan provider".In contrast, a 2010 survey of hospital executives who have dealt with the company, United received a 65% unfavorable rating. While this marks a 33% improvement over the prior year's survey, UnitedHealthcare still ranked last among all listed. Wikipedia.


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LONDON, UK / ACCESSWIRE / May 12, 2017 / Active Wall St. blog coverage looks at the headline from Aetna, Inc. (NYSE: AET) as the health insurance Company announced on May 10, 2017, that it will be exiting from the Affordable Care Act Exchanges at Delaware and Nebraska from 2018. These two were the last states where the Company was offering its affordable health insurance plans in the current year. Register with us now for your free membership and blog access at: One of Aetna's competitors within the Health Care Plans space, Humana Inc. (NYSE: HUM), reported on May 03, 2017, detailed first quarter financial results; and reaffirmed its recent full-year 2017 EPS guidance increase. AWS will be initiating a research report on Humana in the coming days. Today, AWS is promoting its blog coverage on AET; touching on HUM. Get all of our free blog coverage and more by clicking on the link below: In April 2017, Aetna had already announced the exit from exchanges in the states of Iowa and Virginia. At that time, the Company had indicated that it would significantly reduce its participation at the Exchanges. In 2016, the Company had announced that it would exit from 11 states in FY17. The decision was based on the projected losses of more than $200 million expected in the FY17 from the four states where it had been selling its plans. Aetna has already reported a loss of approximately $700 million for the period from FY14–FY16. Aetna spokesperson had explained that "those losses are the result of marketplace structural issues that have led to co-op failures and carrier exits, and subsequent risk pool deterioration." Additionally, Aetna had to bear the cost of the failed merger with Humana. Aetna and Humana called off their merger officially in February 2017, following the US District Court for the District of Columbia ruling in favor of the US Department of Justice which had opposed the merger. Aetna had to pay Humana $1 billion as break-up fee and also call off its agreement with Molina Healthcare, Inc. to sell off some of Medicare Advantage assets and pay the applicable fees associated with that termination. Commenting on the exit from Exchanges in Delaware and Nebraska, Aetna's spokesperson said: "We will not offer on- or off-exchange individual plans in Delaware or Nebraska for 2018, and at this time have completely exited the exchanges." Following Aetna's exit from Delaware and Nebraska, there in only one health insurance Company present in each state that still offers plans at the Exchanges. In Delaware, it is Highmark selling its Blue Cross Blue Shield plans and in Nebraska it is Medica Health, a non-profit insurer. Medica's participation next year is in doubt in view of Medica spokesperson Greg Bury's comments, who said: "We have not made a decision and are reviewing all of our options." Not the Only Health Insurance Company Exiting from Exchanges Health Insurance Companies participating in the Exchanges and offering their health plans have been facing serious problems for the last few years. Firstly, the number of people buying the health plans from exchanges is well below expectations and, on the other hand, the people who bought the plans are sicker than insurers had anticipated which lead to many insurers facing huge losses and thus compelling them to exit from the exchanges. Those insurance Companies who are continuing to offer the health plans under the exchanges have raised their premiums by double-digit percentages, which has left customers in a very vulnerable position as they have fewer Companies offering even fewer health plans from which they can choose. As per the details shared by the Kaiser Family Foundation, on top of Aetna there are other large health insurance Companies such as Anthem Inc., Cigna Corp., and Molina Healthcare Inc. that are already pondering on an exit from the Exchanges; however they are yet to take a final call. Insurance Companies Humana Inc. and UnitedHealth Group Inc. have already exited from most of the government Exchanges. Obamacare, as the Affordable Care Act is also known, has become a political bone of contention between Republicans and Democrats. This issue seems to have reached a critical stage. Obamacare was introduced by President Barack Obama in 2010 as an affordable insurance alternative for all Americans. However, President Donald Trump has been very vocal about his opposition of Obamacare and had promised to repeal Obamacare as a part of his poll campaign. Recently on May 04, 2017, the House of Representatives passed a bill to repeal Obamacare and to replace it with a new health bill called the American Healthcare Act (AHCA). The AHCA has retained some portion of Obamacare; however it has changes in the size and recipients of subsidies. The bill needs Senate's approval before becoming a law. The Democrats at this point cannot do much to block the bill at the Senate as they do not have a majority. But they are gearing up to put up a fight. Recently payments made to insurance Companies for providing subsidized out-of-pocket expenses to low income customers who cannot afford insurance came under scrutiny. President Trump even threatened to withhold key payments to insurance Companies under the Obamacare. The White House has assured that it will continue to pay the subsidies to the insurance Companies, but it has offered no long-term guarantee. This uncertainty has impacted the decision of major health insurance Companies to either exit or consider exiting from Obamacare. On Thursday, May 11, 2017, the stock closed the trading session at $144.39, rising slightly by 0.94% from its previous closing price of $143.04. A total volume of 3.04 million shares have exchanged hands, which was higher than the 3-month average volume of 2.64 million shares. Aetna's stock price surged 19.59% in the last three months, 28.80% in the past six months, and 29.94% in the previous twelve months. Furthermore, since the start of the year, shares of the Company have surged 17.12%. The stock is trading at a PE ratio of 44.81 and has a dividend yield of 1.39%. Active Wall Street (AWS) produces regular sponsored and non-sponsored reports, articles, stock market blogs, and popular investment newsletters covering equities listed on NYSE and NASDAQ and micro-cap stocks. AWS has two distinct and independent departments. One department produces non-sponsored analyst certified content generally in the form of press releases, articles and reports covering equities listed on NYSE and NASDAQ and the other produces sponsored content (in most cases not reviewed by a registered analyst), which typically consists of compensated investment newsletters, articles and reports covering listed stocks and micro-caps. Such sponsored content is outside the scope of procedures detailed below. AWS has not been compensated; directly or indirectly; for producing or publishing this document. The non-sponsored content contained herein has been prepared by a writer (the "Author") and is fact checked and reviewed by a third party research service company (the "Reviewer") represented by a credentialed financial analyst, for further information on analyst credentials, please email info@activewallst.com. Rohit Tuli, a CFA® charterholder (the "Sponsor"), provides necessary guidance in preparing the document templates. The Reviewer has reviewed and revised the content, as necessary, based on publicly available information which is believed to be reliable. Content is researched, written and reviewed on a reasonable-effort basis. The Reviewer has not performed any independent investigations or forensic audits to validate the information herein. The Reviewer has only independently reviewed the information provided by the Author according to the procedures outlined by AWS. AWS is not entitled to veto or interfere in the application of such procedures by the third-party research service company to the articles, documents or reports, as the case may be. Unless otherwise noted, any content outside of this document has no association with the Author or the Reviewer in any way. AWS, the Author, and the Reviewer are not responsible for any error which may be occasioned at the time of printing of this document or any error, mistake or shortcoming. No liability is accepted whatsoever for any direct, indirect or consequential loss arising from the use of this document. AWS, the Author, and the Reviewer expressly disclaim any fiduciary responsibility or liability for any consequences, financial or otherwise arising from any reliance placed on the information in this document. Additionally, AWS, the Author, and the Reviewer do not (1) guarantee the accuracy, timeliness, completeness or correct sequencing of the information, or (2) warrant any results from use of the information. The included information is subject to change without notice. This document is not intended as an offering, recommendation, or a solicitation of an offer to buy or sell the securities mentioned or discussed, and is to be used for informational purposes only. Please read all associated disclosures and disclaimers in full before investing. Neither AWS nor any party affiliated with us is a registered investment adviser or broker-dealer with any agency or in any jurisdiction whatsoever. To download our report(s), read our disclosures, or for more information, visit http://www.activewallst.com/disclaimer/. For any questions, inquiries, or comments reach out to us directly. If you're a company we are covering and wish to no longer feature on our coverage list contact us via email and/or phone between 09:30 EDT to 16:00 EDT from Monday to Friday at: CFA® and Chartered Financial Analyst® are registered trademarks owned by CFA Institute. LONDON, UK / ACCESSWIRE / May 12, 2017 / Active Wall St. blog coverage looks at the headline from Aetna, Inc. (NYSE: AET) as the health insurance Company announced on May 10, 2017, that it will be exiting from the Affordable Care Act Exchanges at Delaware and Nebraska from 2018. These two were the last states where the Company was offering its affordable health insurance plans in the current year. Register with us now for your free membership and blog access at: One of Aetna's competitors within the Health Care Plans space, Humana Inc. (NYSE: HUM), reported on May 03, 2017, detailed first quarter financial results; and reaffirmed its recent full-year 2017 EPS guidance increase. AWS will be initiating a research report on Humana in the coming days. Today, AWS is promoting its blog coverage on AET; touching on HUM. Get all of our free blog coverage and more by clicking on the link below: In April 2017, Aetna had already announced the exit from exchanges in the states of Iowa and Virginia. At that time, the Company had indicated that it would significantly reduce its participation at the Exchanges. In 2016, the Company had announced that it would exit from 11 states in FY17. The decision was based on the projected losses of more than $200 million expected in the FY17 from the four states where it had been selling its plans. Aetna has already reported a loss of approximately $700 million for the period from FY14–FY16. Aetna spokesperson had explained that "those losses are the result of marketplace structural issues that have led to co-op failures and carrier exits, and subsequent risk pool deterioration." Additionally, Aetna had to bear the cost of the failed merger with Humana. Aetna and Humana called off their merger officially in February 2017, following the US District Court for the District of Columbia ruling in favor of the US Department of Justice which had opposed the merger. Aetna had to pay Humana $1 billion as break-up fee and also call off its agreement with Molina Healthcare, Inc. to sell off some of Medicare Advantage assets and pay the applicable fees associated with that termination. Commenting on the exit from Exchanges in Delaware and Nebraska, Aetna's spokesperson said: "We will not offer on- or off-exchange individual plans in Delaware or Nebraska for 2018, and at this time have completely exited the exchanges." Following Aetna's exit from Delaware and Nebraska, there in only one health insurance Company present in each state that still offers plans at the Exchanges. In Delaware, it is Highmark selling its Blue Cross Blue Shield plans and in Nebraska it is Medica Health, a non-profit insurer. Medica's participation next year is in doubt in view of Medica spokesperson Greg Bury's comments, who said: "We have not made a decision and are reviewing all of our options." Not the Only Health Insurance Company Exiting from Exchanges Health Insurance Companies participating in the Exchanges and offering their health plans have been facing serious problems for the last few years. Firstly, the number of people buying the health plans from exchanges is well below expectations and, on the other hand, the people who bought the plans are sicker than insurers had anticipated which lead to many insurers facing huge losses and thus compelling them to exit from the exchanges. Those insurance Companies who are continuing to offer the health plans under the exchanges have raised their premiums by double-digit percentages, which has left customers in a very vulnerable position as they have fewer Companies offering even fewer health plans from which they can choose. As per the details shared by the Kaiser Family Foundation, on top of Aetna there are other large health insurance Companies such as Anthem Inc., Cigna Corp., and Molina Healthcare Inc. that are already pondering on an exit from the Exchanges; however they are yet to take a final call. Insurance Companies Humana Inc. and UnitedHealth Group Inc. have already exited from most of the government Exchanges. Obamacare, as the Affordable Care Act is also known, has become a political bone of contention between Republicans and Democrats. This issue seems to have reached a critical stage. Obamacare was introduced by President Barack Obama in 2010 as an affordable insurance alternative for all Americans. However, President Donald Trump has been very vocal about his opposition of Obamacare and had promised to repeal Obamacare as a part of his poll campaign. Recently on May 04, 2017, the House of Representatives passed a bill to repeal Obamacare and to replace it with a new health bill called the American Healthcare Act (AHCA). The AHCA has retained some portion of Obamacare; however it has changes in the size and recipients of subsidies. The bill needs Senate's approval before becoming a law. The Democrats at this point cannot do much to block the bill at the Senate as they do not have a majority. But they are gearing up to put up a fight. Recently payments made to insurance Companies for providing subsidized out-of-pocket expenses to low income customers who cannot afford insurance came under scrutiny. President Trump even threatened to withhold key payments to insurance Companies under the Obamacare. The White House has assured that it will continue to pay the subsidies to the insurance Companies, but it has offered no long-term guarantee. This uncertainty has impacted the decision of major health insurance Companies to either exit or consider exiting from Obamacare. On Thursday, May 11, 2017, the stock closed the trading session at $144.39, rising slightly by 0.94% from its previous closing price of $143.04. A total volume of 3.04 million shares have exchanged hands, which was higher than the 3-month average volume of 2.64 million shares. Aetna's stock price surged 19.59% in the last three months, 28.80% in the past six months, and 29.94% in the previous twelve months. Furthermore, since the start of the year, shares of the Company have surged 17.12%. The stock is trading at a PE ratio of 44.81 and has a dividend yield of 1.39%. Active Wall Street (AWS) produces regular sponsored and non-sponsored reports, articles, stock market blogs, and popular investment newsletters covering equities listed on NYSE and NASDAQ and micro-cap stocks. AWS has two distinct and independent departments. One department produces non-sponsored analyst certified content generally in the form of press releases, articles and reports covering equities listed on NYSE and NASDAQ and the other produces sponsored content (in most cases not reviewed by a registered analyst), which typically consists of compensated investment newsletters, articles and reports covering listed stocks and micro-caps. Such sponsored content is outside the scope of procedures detailed below. AWS has not been compensated; directly or indirectly; for producing or publishing this document. The non-sponsored content contained herein has been prepared by a writer (the "Author") and is fact checked and reviewed by a third party research service company (the "Reviewer") represented by a credentialed financial analyst, for further information on analyst credentials, please email info@activewallst.com. Rohit Tuli, a CFA® charterholder (the "Sponsor"), provides necessary guidance in preparing the document templates. The Reviewer has reviewed and revised the content, as necessary, based on publicly available information which is believed to be reliable. Content is researched, written and reviewed on a reasonable-effort basis. The Reviewer has not performed any independent investigations or forensic audits to validate the information herein. The Reviewer has only independently reviewed the information provided by the Author according to the procedures outlined by AWS. AWS is not entitled to veto or interfere in the application of such procedures by the third-party research service company to the articles, documents or reports, as the case may be. Unless otherwise noted, any content outside of this document has no association with the Author or the Reviewer in any way. AWS, the Author, and the Reviewer are not responsible for any error which may be occasioned at the time of printing of this document or any error, mistake or shortcoming. No liability is accepted whatsoever for any direct, indirect or consequential loss arising from the use of this document. AWS, the Author, and the Reviewer expressly disclaim any fiduciary responsibility or liability for any consequences, financial or otherwise arising from any reliance placed on the information in this document. Additionally, AWS, the Author, and the Reviewer do not (1) guarantee the accuracy, timeliness, completeness or correct sequencing of the information, or (2) warrant any results from use of the information. The included information is subject to change without notice. This document is not intended as an offering, recommendation, or a solicitation of an offer to buy or sell the securities mentioned or discussed, and is to be used for informational purposes only. Please read all associated disclosures and disclaimers in full before investing. Neither AWS nor any party affiliated with us is a registered investment adviser or broker-dealer with any agency or in any jurisdiction whatsoever. To download our report(s), read our disclosures, or for more information, visit http://www.activewallst.com/disclaimer/. For any questions, inquiries, or comments reach out to us directly. If you're a company we are covering and wish to no longer feature on our coverage list contact us via email and/or phone between 09:30 EDT to 16:00 EDT from Monday to Friday at: CFA® and Chartered Financial Analyst® are registered trademarks owned by CFA Institute.


News Article | May 17, 2017
Site: news.yahoo.com

(Reuters) - The U.S. Justice Department for the second time in a month sued UnitedHealth Group Inc on Tuesday, accusing the nation's largest health insurer of obtaining over $1 billion from Medicare to which it was not entitled. The complaint, filed in federal court in Los Angeles, came after the Justice Department brought a separate but similar case against UnitedHealth. In both cases, the government intervened in whistleblower lawsuits against UnitedHealth. The latest complaint came after the Justice Department intervened in a lawsuit brought by former UnitedHealth executive Benjamin Poehling, whose whistleblower case was filed under seal in 2011. UnitedHealth had no immediate comment. It previously said it rejects the claims in the underlying whistleblower lawsuit and would fight the claims vigorously. Medicare, a government health insurance program, serves more than 50 million Americans who are elderly or disabled. More than one-third of them are in Medicare Advantage plans run by private insurers like UnitedHealth. In the lawsuit, the Justice Department alleged that UnitedHealth obtained inflated risk adjustment payments based on untruthful and inaccurate information about the health status of patients enrolled in its Medicare Advantage plans. The lawsuit said UnitedHealth's conduct damaged the Medicare program by over $1.14 billion from 2011 to 2014. The Justice Department said it is seeking triple damages under the False Claims Act as well as penalties. Poehling filed his lawsuit under the False Claims Act, which allows whistleblowers to sue companies on the government's behalf to recover taxpayer money paid out based on fraudulent claims. If successful, whistleblowers receive a percentage of the recovery. A government decision to intervene is typically a major boost to such cases. Poehling also sued other insurers, claiming that they along with UnitedHealth had defrauded the United States of hundreds of millions - and likely billions - of dollars through claims for payments from Medicare for the elderly. While the Justice Department has not pursued claims against other companies, in March it said it was investigating Centene Corp's Health Net Inc, Aetna Inc, Cigna Corp's Bravo Health Inc and Humana Inc. The Justice Department has also intervened in a related whistleblower lawsuit brought by James Swoben, a former Senior Care Action Network Health Plan employee and a consultant to the risk adjustment industry. The case is U.S. ex rel. Benjamin Poehling v. UnitedHealth Group Inc et al, U.S. District Court, Central District of California, No. 16-cv-08697.


Patent
UnitedHealth Group Inc. | Date: 2016-03-31

Computer program products, methods, systems, apparatus, and computing entities are provided for sessions with participants and providers. For example, in one embodiment, a provider can interact with multiple participants to conduct interactive treatment sessions. Further, a participant can interact with multiple providers to conduct interactive treatment sessions. For the interactive treatment sessions, motion data and video data of the participant can be simultaneously displayed to the provider.


Patent
UnitedHealth Group Inc. | Date: 2013-06-07

Computer program products, methods, systems, apparatus, and computing entities are provided for sessions with participants and providers. For example, in one embodiment, a provider can interact with multiple participants to conduct interactive treatment sessions. Further, a participant can interact with multiple providers to conduct interactive treatment sessions. For the interactive treatment sessions, motion data and video data of the participant can be simultaneously displayed to the provider.


Consumer healthcare decisions are facilitated using systems, methods and computer program products configured to generate healthcare path recommendations based a consumer engagement with a consumer interface in which consumer-reported information related to a consumer health condition is received and used to generate healthcare path recommendations. The healthcare path recommendations are customized for the consumer based on the consumers personalized information including the consumers engagement with the consumer interface. The customized healthcare paths include treatment options for addressing the health of the consumer and may include cost-effective providers.


Patent
UnitedHealth Group Inc. | Date: 2013-02-25

Data is obtained from medical service providers. The data includes at least a plurality of available medical service appointments and pricing information. An inquiry for a medical service appointment is received from a user. A number of available medical service appointments are selected based on the inquiry and are then presented to the user. Prices for the available medical service appointments may be included and may be calculated based on current healthcare benefit plan information for the user. In response to a received purchase indication, one of the presented medical service appointments are purchased for the user.


Patent
UnitedHealth Group Inc. | Date: 2015-11-10

Systems and methods for intelligently routing a member of an organization to a single point-of-contact within an optimized, secure network to address all the members healthcare needs are described. The disclosed intelligent routing configurations transform and process, in real-time, vast amounts of member data to generate specialized effort scores specific to each members household. The effort scores, among other things, are used to determine an appropriate tier within the organization to route the member, and its account file containing real-time member and household level data.


Patent
UnitedHealth Group Inc. | Date: 2014-05-19

Healthcare costs accumulated across a plurality of claims systems are managed using a centralized accumulator, which receives cost accumulator data for adjudicated claims from multiple sending claim systems. An accumulator record type is identified from the cost accumulator data and used to generate a cross-reference record. The record type includes an adjudicated claim. A routing message is generated for at least one receiving claim system according to the identified accumulator record type, the cost accumulator data received from the sending claim system, and an identity of the at least one receiving claim system. In response to sending the routing message to the receiving claim system, an acknowledgement is received, which is used to update the cross-reference record by the processor.


Disclosed embodiments include methods and systems for creating and utilizing derived medical records. In accordance with one or more embodiments, a derived medical record system may utilize one or more derived medical records to improve insight into patient health, identify future risk factors, and improve claim processing efficiency. In some examples, the derived medical record system may further provide derived medical records based on healthcare data stored in structured and unstructured data sources.


Patent
UnitedHealth Group Inc. | Date: 2014-03-14

A method for directing inquiries to available subject matter experts includes storing an expert database in memory and defining presence states to describe present attributes of each subject matter expert with respect to a number of resource elements. Inquiries are directed to the experts, and response histograms are populated based on whether a response was obtained in a given presence state. The response histograms describe or define a response probability for each subject matter expert, as a function of the corresponding present attributes for each of the resource elements.

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