Center for Health & Democracy, July 16, 2025
Shining a light on a giant
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.
Introduction
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.
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.
full report: https://sunlightreportinsurance.com…