Shining a light on a giant.
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The Sunlight Report on UnitedHealth Group is a first-of-its-kind look at the nearly 2,700 acquisitions and internally created subsidiaries that make up UnitedHealth Group, the largest health care conglomerate in the world.
Named for its mission to bring light to UnitedHealth’s vast and often opaque business structure, this project compiles and analyses publicly available data in an accessible way, allowing the public to more clearly grasp the scope of the company’s reach.
UnitedHealth Group has evolved from a small U.S. health insurer into a massive health care conglomerate through decades of strategic acquisitions and vertical integration. It provides health insurance and related services globally and is broadly divided into its insurance arm (UnitedHealthcare) and another major division (Optum), which provides other health care-related services. As of the fourth quarter of 2024, UnitedHealth operated in almost every country in the world, had more than 400,000 employees, and reported 2024 revenue of $400 billion. Through its vertical integration and acquisitions, it now employs or has close contractual ties with more than 90,000 doctors (nearly 10% of the entire U.S. physician workforce) and commands 15% of the U.S. health insurance market. As a result of this vertical integration strategy, almost 30% of total company revenue is now generated by internal business entities.
(The relevant accounting term to further explain the significance of that percentage is “intercompany eliminations.” In its financial disclosures, UnitedHealth must report intercompany eliminations to avoid double counting. This is because the company is paying itself in many instances, i.e., UnitedHealthcare, the insurer, increasingly is paying health care providers (grouped under Optum) that it owns or otherwise controls. In 2010, before UnitedHealth had acquired most of its clinical assets and when the company’s revenues were $94.2 billion, eliminations totaled $18.3 billion, or approximately 16% of total revenue. In 2024, after hundreds of acquisitions of physician practices and other clinical assets and when the company’s revenues totaled $400.3 billion, eliminations had reached $150.9 billion, or 27.4% of total revenue. Here’s another way of looking at this: The eliminations in 2024 represented nearly 60% of Optum’s total revenues.)
The sheer size and complexity of the organization, coupled with its rapid pace of acquisitions, makes it difficult for consumers, regulators, policymakers, employers and other group purchasers of health insurance to understand the inner workings of the organization. This is compounded by often insufficient granularity in UnitedHealth’s financial and regulatory reporting. For example, current financial reporting aggregates data from multiple entities and regions, often without clear delineation of contributions by subsidiary or geography. This makes it difficult to analyze the performance (and significance) of its many individual components. Similarly, corporate filings and disclosures often do not include information about entity-specific operations and people.
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We believe these factors leave the public without critical information needed to understand how UnitedHealth’s size and structure affects health care access, quality, and affordability. The details of many of its acquisitions are not publicly disclosed, which, coupled with its byzantine structure, deters most people from learning more or understanding what is at stake.
That is why we undertook the massive project of helping the public understand this corporation, which has grown to become the fourth largest on the Fortune 500 list of American companies. The goal of our work was to:
1. Characterize the structure and function of the various entities that comprise UnitedHealth;
2. Detail its rapid growth through acquisitions and how it has evolved along with its vertical integration strategy.
The sunlight
report
What our work
reveals
We believe this information will help consumers, policymakers, health care providers, regulators and anyone else who has an interest in ensuring the quality, access, and affordability of our health care system.
​As of the third quarter of 2024, UnitedHealth was composed of approximately 2,700 distinct legal entities (i.e., subsidiaries). These entities largely fall into one of five functional areas:
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Insurance entities, including health, dental, vision, and non-health related insurers such as life and disability;
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Clinical entities that provide direct clinical care or services to patients. In this category we also included entities that provide administrative support to clinical subsidiaries, in service of their operations (e.g., Independent Practice Associations (IPAs), Management Service Organizations (MSOs), etc.);
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Pharmacy, including specialty pharmacy, infusion, and pharmacy benefits management;
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International entities, which usually are large conglomerates that provide both insurance and health care-related services; and
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Other entity types including areas such as consulting, technology, real estate/property management, etc.​
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Prior to 2010, UnitedHealth's strategic acquisitions were largely focused on expanding and diversifying its health insurance operations. Notable acquisitions and mergers during this period included:
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AmeriChoice (2002)
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Mid Atlantic Medical Services (2003)
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PacificCare Health Systems (2005)
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Sierra Health Services (2008)
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Over the past decade, the number of UnitedHealth entities has increased more than 10-fold, from approximately 220 in 2013 to 2,700 in 2023.
UnitedHealth
subsidiaries by business type
Clinical
Insurance
Other
Pharmacy
International
100+ entities
100+ entities
150+ entities
200+ entities
2050+ entities
Growing and
growing
During this period, UnitedHealth shifted its strategy toward acquiring clinical and health care service-related clinical entities (including provider groups, ambulatory surgery centers (ASCs), home care organizations and technology assets (e.g., claims processing, payment integrity, revenue cycle management, etc.) to support both its insurance and clinical operations.
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Notable acquisitions during this period include:
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$2.3B acquisition of SCA Health, the second-largest ambulatory surgery center (ASC) operator with 320 facilities.​​
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$3.4 billion acquisition of DaVita Medical Group (2019), a large multi-specialty medical group.
NOTE: After the acquisition, DaVita Medical Group was rebranded under Optum Health, which is part of OptumCare, UnitedHealth’s rapidly growing network of medical practices, urgent care centers, and specialty clinics.
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$3.2 billion acquisition of Equian (2019) for payment processing services.
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$3.5 billion acquisition of Landmark Health (2021), which specializes in providing in-home medical care for patients with complex, chronic conditions.
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$8 billion acquisition of Change Healthcare, which provides data, analytic and technology capabilities for claims and payment management.
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$5.4 billion acquisition of LHC Group (2023), which has an extensive network of home health and hospice services (700 locations across 37 states).
UnitedHealth
subsidiary growth
Years
3000
2500
2000
1500
1000
500
20
10
20
11
20
12
20
13
20
14
20
15
20
16
20
17
20
18
20
19
20
20
20
21
20
22
20
23
0
Clinical
growth
HealthSmart Rx Solutions, Inc
2023
Landmark Health
2021
OMCO, INC
2015
Equian
2019
1000
300
200
600
500
400
900
800
700
100
Unique legal entities (number)
0
20
10
20
11
20
12
20
13
20
14
20
15
20
16
20
17
20
18
20
19
20
20
20
21
20
22
20
23
Years
LHC Group
2023
Unique legal entities (number)
DaVita Medical Group
2019
Optum360
2012
Catamaran
2015
Shift to
patient care
UnitedHealth’s Clinical enterprise now spans clinical services delivered “cradle to grave” in various physical settings (clinics, home, ambulatory surgical centers), and across numerous clinical domains (including primary care, specialty care, behavioral health, urgent care, imaging, home health, palliative care and hospice). In addition to the clinicians it employs, UnitedHealth has contractual relationships with many independent physicians through entities it owns, namely IPAs and Accountable Care Organizations.
Multi-Specialty Care
Primary Care
Homecare
Behavioral Health
ASC
Admin Support
0
100
200
300
400
500
600
700
800
900
Unique legal entities (number)
Clinical growth
by subtype
Taxpayer-Funded
business
Medicare Advantage • Medicaid • Military
UnitedHealthcare has far more Medicare Advantage enrollees than any other company. At the end of the most recent open enrollment period, for 2025, UnitedHealth gained 400,000 new Medicare enrollees, largely at the expense of the second and third largest Medicare Advantage companies, Humana and CVS/Aetna, which lost enrollees and market share to UnitedHealth as those companies decided to stop selling policies in many communities. Almost a third of the 34.1 million Medicare Advantage enrollees are now enrolled in a UnitedHealthcare plan, far more than any other company.
Even though UnitedHealthcare has three times more people enrolled in its commercial plans (for people 65 and younger) than in its Medicare Advantage plans (which it markets with AARP), it reported almost twice as much revenue, mostly from the federal government, for its Medicare/retirement business in 2024 ($139.5 billion) than from its commercial customers, including employers ($74.5 billion).
UnitedHealth also reported more revenue from Medicaid and other state and federal government programs serving low-income Americans in 2024 ($80.6 billion) than from its commercial health plans.
In addition, through its subsidiary Optum Serve, UnitedHealth plays a major role in delivering health services to U.S. veterans. Optum Serve is the third-party administrator for the Department of Veterans Affairs’ Community Care Network (CCN) in Regions 1, 2, and 3, which covers much of the eastern and central U.S.
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Optum Serve is also contracted with The Department of Health and Human Services and the Department of Defense to conduct medical disability exams for veterans; provide telephone-based “lifestyle coaching”; and develop Clinical Practice Guidelines.
Altogether, 75% of UnitedHealthcare’s U.S. revenues of $295 billion in 2024 came from federal and state taxpayers. Only 25% came from individuals, employers and other private (nongovernmental) group purchasers.
Major
themes
UnitedHealth has acquired numerous entities that drive business to or that support the operations of one or more of its other owned entities. For example, MSOs provide management services to physician practices, including coding and documentation, revenue cycle management, and credentialing. To support its insurance operations, UnitedHealth owns an array of distribution channels, including brokerages, call centers and even travel agencies that support its extensive international travel insurance operations.
Several other themes emerged from our analysis:
Theme 1
Among the thousands of subsidiaries are the significant number that do not appear to have assets, operations, or employees but seem to have been designed for other business purposes, most commonly to serve as “holding companies”, to facilitate mergers and acquisitions or to manage international business operations. Little public information is available about many of these entities, so we could only make inferences about their business purposes, given the size and complexity of the organization.
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Theme 2
UnitedHealth has expansive international operations, although as noted above detailed information about the operations and finances of these entities is limited (as are the availability of foreign registrations or business descriptions, if required, since they are subject to different legal and regulatory requirements in local jurisdictions). To us, these entities seem to operate largely camouflaged from the view of U.S. regulators, consumers and shareholders.
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Theme 3
Third, beyond clinical assets, UnitedHealth’s expansion into other company types (in some cases seemingly not health care related) is noteworthy; this activity has accelerated more recently, with 92 related acquisitions since 2016.
Examples include:
1) Exploration for Mine Clearance, LLC, a company domiciled in Iraq;
2) Optum Ventures, a venture capital firm with >$2 billion in assets under management;
3) Optum Insight Life Sciences, which partners with 120 life sciences companies and supports the design and conduct of clinical trials;
4) RVO Health, LLC, a joint venture between Optum and Red Ventures. Red Ventures is a major, global digital media company that operates more than 100 digital brands (including healthline.com and medicalnewtsoday.com) and has more than 1 billion monthly readers.
Why you should
care
UnitedHealth Group has pursued a vertical integration strategy largely through acquisitions, increasing 10-fold in size over the past decade and at last count consisting of 2,694 distinct legal entities. (It likely already is more than 3,000. As STAT News recently reported, the company acquired more than 200 additional clinical operations in 2024 alone.) Clinical subsidiaries, including physician groups, ambulatory surgery centers and home care organizations (including palliative care and hospice) now comprise the majority of these entities. We believe this trend is noteworthy given that it enables UnitedHealth to shift expenses (and profits) between its insurance arm and care delivery assets.
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We suspect few consumers are aware that their doctors could be part of a broader enterprise that, as a publicly traded company, has a legal obligation, first and foremost, to maximize shareholder value. The tension between care and profits comes into stark contrast in areas such as hospice care, which can benefit from limiting treatment and maximizing revenue.
This vertical integration strategy enables UnitedHealth to influence or control the financial and clinical continuum of patient care for millions of Americans.
Research
methods
Information about UnitedHealth’s subsidiaries were abstracted from Schedule Y filings with state regulators, which require disclosures on related party insurer members of a holding company and are publicly available. We downloaded separate Schedule Ys for each year from 2010-2024. We used year-end Schedule Ys whenever possible; however, occasionally the only Schedule Y we could locate for a given year was from a prior quarter (e.g., Q3 instead of year-end). We were unable to locate Schedule Ys prior to 2010, so we relied on other filings and published reports for acquisitions made during this time period. Because many of the files were available only as PDF images and did not contain structured data, we manually abstracted the company names, identification numbers and the controlling (parent) entity for each year. For any controlling entity, if there were multiple owners, we included the entity with the largest ownership percentage listed in the Schedule Y. If there were multiple owners with equal percentages, we listed all of them as the “controlling entity”. There were multiple instances where the same company was listed multiple times on the Schedule Y. In these cases, we removed the duplicate entries (as identified by ID# and/or company name).
We merged the data across years by linking federal identification numbers (when available), or by name if they were missing. Since the details of many of the acquisitions are not publicly reported, we estimated the establishment date based on when it first appeared in a Schedule Y filing. For example, if a company first appeared on a Schedule Y in 2023, we listed the establishment date as occurring sometime between January 1, 2022, and December 31, 2022. (Because the Schedule Ys do not indicate whether a subsidiary was created inorganically through an acquisition or organically through a new company creation, we use the term “establishment date”).
We also researched public information about each company, including its purpose and operations. We used Google search and supplemented our queries with ChatGPT and Perplexity, as needed, to help ensure access to the greatest number of publicly available sources. We developed a basic taxonomy to classify companies based on their primary function into one of five categories. It was developed using an iterative approach and based on the input of a multi-functional team of experts. In cases where we had limited information about the company, we made our final classification based on its position within UnitedHealth’s published organizational structure and its relationship to other known entities. The classification approach we used is fallible due to a variety of factors, including the availability of information and the multi-purpose nature of companies that don’t fall neatly into one category or another. However, our intent was to create a basic way for the public to understand the main functional components of the company, outside of a complex organizational chart.
In partnership
The Sunlight Report on UnitedHealth Group is a project of the Center for Health & Democracy (CHD), made possible through funding from Arnold Ventures. In early 2024, Arnold Ventures approached CHD with the idea of compiling and publishing a public record of UnitedHealth Group’s vast corporate structure. The grant funding supports CHD’s efforts to collect, analyze, and present this data, drawn from the company’s filings with regulatory agencies over several years, in a publicly accessible format. The goal of the Sunlight Report is to provide greater transparency for all of the company’s stakeholders and the general public. The information provided on this website is for general educational and informational purposes only. All data in the Sunlight Report is drawn from publicly available documents. Neither CHD nor any of its funders is responsible for any errors or omissions in the original source data, and while CHD has sought to accurately relay such data in this report, transcription and editorial errors may have occurred and neither CHD nor any of its funder can accept liability for any such inaccuracies or errors.
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We published this project in the pursuit of transparency. If anything appears to be inaccurate, we encourage any outreach at info@sunlightreportinsurance.com.
Disclaimer
The information provided herein has been obtained and compiled from publicly-available sources and is not intended to be relied upon as definitive. The Schedule Y annual statement requires an insurance holding company system to report the names of parent, subsidiaries, and affiliates. For simplicity, we refer to all entities under the UnitedHealth Group umbrella as “subsidiaries.” While every effort has been made to ensure the accuracy of the information, the Center for Health & Democracy (CHD) makes no representations or warranties regarding the completeness, reliability, or accuracy of any statements or data contained herein. CHD, on behalf of itself and its funders, expressly disclaims any liability for errors or omissions in the content provided. All expressions of opinion herein are subject to change without notice and CHD is not obligated to correct, update or supplement this report or any of the information contained herein.