UnitedHealthcare's disturbing track record of rejecting claims has come under the spotlight after the insurance giant's CEO was shot dead in what is believed to have been a targeted attack in the heart of Manhattan.
Brian Thompson, 50, was gunned down around 6:45am on Wednesday outside a Hilton Hotel in Midtown. The masked attacker remains on the loose and has not yet been identified. Their motive for the shooting has not been disclosed.
UnitedHealthcare was being probed by the Department of Justice for alleged antitrust violations, while its parent company, UnitedHealthcare Group (UHG), has come under fire from angry patients who claim the insurer refused to cover their care.
UHG is the nation's largest health insurance conglomerate. The company expected to bring in revenues of $450 billion in 2025, with Thompson believed to earn a salary in the region of $10million a year.
In July, more than 150 protesters from the People's Action Institute campaign group gathered outside UHG's headquarters in Minnetonka, Minnesota, in what became a fiery demonstration.
Police moved in and arrested 11 people who were later charged with misdemeanors related to blocking the public highway outside the building, according to online clinical publication Dark Daily.
'UnitedHealth Group's profiteering by denying care is a disgrace, leaving people across Minnesota and all of the United States without the care they desperately need,' campaigners wrote in a letter to UHG's CEO Andrew Witty.
UnitedHealthcare's parent company, UnitedHealthcare Group (UHG), has come under fire in recent years by furious patients who claim the insurer refused to cover their care - leaving them out of pocket or struggling without medical attention. (Pictured: a July protest)
UnitedHealthcare CEO Brian Thompson was shot and killed outside Manhattan's Hilton Hotel
Witty was also at the Hilton Hotel when Thompson was shot dead. He halted a meeting there just after 8am after hearing about the murder of his business partner.
'Health insurance coverage has expanded in America, but we are finding it is private health insurance corporations themselves that are often the largest barrier for people to receive the care they and their doctor agree they need,' protester Aija Nemer-Aanerud, campaign director with the People's Action Institute, told CBS News in July.
Nemer-Aanerud said UHG's leadership specifically had 'refused to acknowledge that prior authorizations and claim denials are a widespread problem.'
'The safety and security of our employees is a top priority,' UnitedHealthcare said in a statement at the time.
'We have resolved the member-specific concerns raised by this group and remain open to a constructive dialogue about ensuring access to high-quality, affordable care.'
UnitedHealthcare was also accused of using AI to deny claims for post-acute care services in Medicare Advantage in a lawsuit slated earlier this month, according to Fierce Healthcare.
The proposed class action was filed by families of two senior Medicare Advantage members who died after the insurer allegedly used the NaviHealth platform illegally to reject care, as UHG profits ballooned.
According to the lawsuit, the technology has a '90 percent error rate, and the company relies on patient complacency or lack of knowledge about the systems to keep using it.
'Defendants bank on the patients' impaired conditions, lack of knowledge, and lack of resources to appeal the erroneous AI-powered decisions,' they said in the lawsuit.
In July more than 150 protesters from the People's Action Institute campaign group gathered outside UHG's headquarters in Minnetonka, Minnesota, in what became a fiery demonstration
UnitedHealthcare's parent company, UnitedHealthcare Group (UHG), has come under fire in recent years by furious patients who claim the insurer refused to cover their care. Many staged protests like the above demonstration in Minnesota in April
Pictured: Protesters with People's Action target health insurance giant UnitedHealth Group due to exorbitant health insurance costs and insurance claims denials on April 16, 2024 in Eden Prairie, Minnesota
In a statement to Fierce Healthcare, UnitedHealth said the lawsuit 'had no merit' because they were not using NaviHealth to make decisions on coverage.
'The NaviHealth predict tool is not used to make coverage determinations,' a spokesperson said.
'The tool is used as a guide to help us inform providers, families and other caregivers about what sort of assistance and care the patient may need both in the facility and after returning home.
'Coverage decisions are based on CMS coverage criteria and the terms of the member's plan.'
According to a recent investigation into the company by Stat News, internal documents showed that NaviHealth set a 2023 target to keep rehab stays of patients in Medicare Advantage plans within 1 percent of the days projected by the algorithm.
Former employees said they were forced to abide by this rule, or face discipline or even termination of their roles, regardless of whether the extra days were justified under Medicare coverage rules.
The performance goal was part of a wider effort to reduce nursing care home costs for elderly patients with privatized Medicare plans, per Stat News.
The outlet cited disturbing patient case studies, including an elderly woman who was part-paralyzed by a stroke allegedly being allotted only 20 days of rehab by the algorithm - less than half of the average.
Another case study includes a 78-year-old legally blind man with failing heart and kidneys, who was granted only 16 days in a nursing home.
DailyMail.com has contacted UHG for comment on all of the above allegations.
Pictured: Protesters with People's Action target health insurance giant UnitedHealth Group due to exorbitant health insurance costs and insurance claims denials on April 16, 2024
A huge police presence descended on the scene Wednesday morning. The NYPD has not yet stated a motive
Earlier this year, the DoJ launched a probe into whether UnitedHealthcare was unfairly restricting competitors and running a monopoly.
The DoJ also sued to block the company's acquisition of home health and hospice provider Amedisys, naming Thompson and others and accusing them of unlawful practices.
Thompson was accused of being aware of the DoJ probe into the company and not telling investors before he unloaded over 31 percent of his stock.
Last month, Simply Wall Street reported that amid the probe and lawsuit, UnitedHealthcare insiders had sold $16million of their stock.
Thompson was the biggest insider seller, unloading $12million worth of shares, at about US$521 per share.
'We are challenging this merger because home health and hospice patients and their families experiencing some of the most difficult moments of their lives deserve affordable, high quality care options, said Attorney General Merrick B. Garland.
'The Justice Department will not hesitate to check unlawful consolidation and monopolization in the healthcare market that threatens to harm vulnerable patients, their families, and health care workers.'
Thompson was accused of being aware of the DoJ probe into the company, and not telling investors before he unloaded over 31 percent of his stock
Flags flew at half-mast at the UnitedHealthcare headquarters in Minnetonka, Minnesota on Wednesday following the slaying of the executive
On Wednesday morning, Thompson was fatally shot in the chest and leg in a targeted attack by a masked man, who then fled down 6th Avenue on a bicycle.
The NYPD has launched a huge manhunt to catch the killer, who is believed to have escaped into Central Park.
Witnesses said the suspected gunman was seen waiting outside the hotel before the shooting, and knew which door Thompson was going to emerge from before shooting him at point-blank range.
The CEO was rushed to Mount Sinai Hospital in critical condition, and was later pronounced dead.
Flags flew at half-mast at the UnitedHealthcare headquarters in Minnetonka, Minnesota on Wednesday following the slaying of the executive.
Thompson was named UnitedHealthcare CEO in 2021 and earned a reported $10 million a year, and for several years prior, he ran the Medicare business within UnitedHealthcare.
He was slated to speak at an investor meeting at the Hilton Hotel soon after the shooting. According to a release from United Healthcare on Tuesday, he would announce the company's hugely profitable 2025 financial outlook, including expected revenues upwards of $450 billion.
The suspect is at large, and is described as a white male wearing a cream-colored jacket, black face mask, black and white sneakers, and a grey backpack.
Thompson was named UnitedHealthcare CEO in 2021 and earned a reported $10 million a year. He is survived by his wife Paulette 'Pauley' Thompson, 51, and their two children who live in the family's $1.5 million home in Maple Grove, Minnesota.
