UnitedHealth announced Tuesday that an audit conducted by an outside consulting firm found that roughly 97% of diagnoses generated through its HouseCalls home-health program in 2025 were backed up by patients’ existing medical records.
Wyatt Decker, an executive vice president at UnitedHealth, responded to the findings by saying, “We look at this with both a sense of pride, but also humility,” and noted the company wants to ensure that nurse practitioners are documenting diagnoses in a way that more accurately reflects what patients are actually experiencing.
According to the Wall Street Journal, the Department of Health and Human Services has been examining diagnoses that show up only in UnitedHealth’s home-visit assessments and nowhere else in a patient’s medical file. Diagnoses submitted through the HouseCalls program play a role in determining how much the federal government pays UnitedHealth’s insurance division, UnitedHealthcare, through Medicare Advantage.
The audit revealed that 3.4% of diagnoses made by HouseCalls clinicians this year were not supported by medical records. HouseCalls operates under UnitedHealth’s Optum primary care division and dispatches clinicians to patients’ homes each year to conduct physical exams and review medical histories. UnitedHealthcare manages Medicare Advantage plans for Americans aged 65 and older, as well as individuals with disabilities.
In a letter addressed to company stakeholders, CEO Stephen Hemsley pledged that UnitedHealth would work to do better and argued that home visits help elderly patients avoid costly medical emergencies down the road.
Hemsley had promised a thorough review of the company’s operations last year after UnitedHealth fell short of its own profit forecasts for the first time since 2008. The company hired business consulting firm FTI Consulting to carry out the analysis.
FTI had previously flagged that UnitedHealth sometimes lacked consistent documentation standards within the HouseCalls program. The latest report examined 200 home visits, covering a total of 494 diagnoses. Decker noted that the report has not yet led to any changes in company policy.
