The U.S. government is cracking down on bad actors in the healthcare sector, with special attention to United Health. The healthcare giant – the largest company in the industry – is now undergoing a criminal probe by the Department of Justice for engaging in alleged Medicare fraud in addition to possible antitrust violations and a civil investigation.
These inquiries into United Health’s shady operations prove that American patients aren’t the only ones sounding the alarm over a severe lack of price transparency and price gouging in an industry that is costing them their health. With better oversight, transparency, and consequences for fraudulent billing practices, patients might soon experience an authentically patient-focused healthcare system.
Tragically, United Health is not alone. Other top industry players are facing similar scrutiny for similar activities. Last month, the DOJ filed a complaint against Aetna Inc. and affiliates, Elevance Health Inc., and Humana Inc. alleging that they paid hundreds of millions of dollars in illegal kickbacks to insurance brokers in exchange for enrollments into the insurers’ Medicare Advantage plans. Aetna and Humana are also alleged to have discriminated against patients with disabilities for financial gain.
To understand just how much sweeping control these players have over the cost and coverage of U.S. healthcare, it can help to look at the numbers. United Health alone is the biggest company in the insurance industry by market cap, worth nearly $275 billion. It controls an estimated 15 percent of the U.S. health insurance market and serves more than 29 million Americans, according to a 2024 report from the American Medical Association. Meanwhile, competitors Elevance Health and CVS Health control an estimated 12 percent of the market each.
The size and scope of these companies might not be a problem if they did not regularly sacrifice patients for profits. In 2024, United Healthcare settled a case brought forward by a severely ill student at Penn State University who suffered from ulcerative colitis, a condition requiring medical treatment totaling $2 million a year. The student claimed United Healthcare denied him coverage for drugs his doctors told him were medically necessary to treat his symptoms, forcing him to pay a bill of more than $800,000. ProPublica reporting reveals that United Healthcare buried the student’s medical reports to reject his insurance claims.
Widespread lack of medical transparency also provides an open door for bad actors to hide prices from patients until they receive costly bills in the mail following treatment. This has been going on for far too long already. In fact, nearly 80 percent of American hospitals blatantly refuse to post costs of essential medical procedures on their websites for patients to compare and calculate in advance of treatment as they are legally required to do. This often causes patients to delay vital care from fear that they will be unable to afford the bill imposed upon them by careless and often predatory medical companies.
What patients really deserve is honest price reporting by hospitals and insurance companies alike. A recent poll conducted by PatientsRightsAdvocate.org shows that nearly every American agrees that they “deserve to know the price of their healthcare before they receive it.” A whopping 94 percent agree that “lower healthcare prices will be a big deal for American families trying to get by” and make ends meet. What’s more – nearly 85 percent think that “price transparency will help bring down healthcare costs… by making it harder for hospitals or insurers to overcharge patients.”
It is essential that the federal government act on President Trump’s February 2025 executive order which seeks to enforce federal healthcare price transparency law. The order is key to bringing much needed relief to the patients suffering from our broken healthcare system. It builds on rules that first went into effect in 2021 and requires hospitals to publish “machine-readable file[s] with negotiated rates for every single service” they provide.
In the meantime, we at Solidarity HealthShare will continue to do our part to ensure that patients get the care they need at a rate they can afford. The days of healthcare sticker shock and overcharging must end, with ethical, affordable care made available to all as it was always intended to be.
