UnitedHealth Group Is a Loan Shark – and It’s Killing Independent Healthcare Providers.

The insurance conglomerate has said its bank will be “a very, very material-scale business for us.”

Credit: iStock/JHVEPhoto

By Emma Freer, Sr. Policy Analyst for Healthcare

Fruth Pharmacy, a 73-year-old independent pharmacy that once had 28 locations in West Virginia and Ohio, closed last month. The “Big Three” pharmacy benefit managers (PBMs) – CVS Caremark, Cigna Group’s Express Scripts, and UnitedHealth Group’s OptumRx, which control 80% of U.S. prescriptions and are each vertically integrated with a major insurance conglomerate – are largely to blame, wielding their market power to not only drive costs up for patients but also drive down payments to unaffiliated pharmacies for filling scripts.

But Fruth CEO Andy Becker pointed to an additional cause: the February 2024 cyberattack on Change Healthcare, the nation’s largest health insurance claims processor, which UnitedHealth Group acquired in 2022. The attack left Fruth – and countless other pharmacies – unable to fill prescriptions or process claims for nearly a week, leading to a loss of customers, many of whom never returned.

Yet UnitedHealth Group ultimately financially benefited from the attack. That’s because it extended emergency loans to more than 10,000 impacted medical providers via its banking arm, Optum Financial. In fact, the bank furthers UnitedHealth Group’s dominance, ensuring providers are reliant on the conglomerate not only for payment and claims processing but also for capital.

But why does UnitedHealth Group even have a bank in the first place?

In a new policy brief, “UnitedHealth Group Is a Bank: How Policymakers Can Protect Independent Physician Practices from Becoming Loan Shark Bait,” I try to answer this question by digging into the origins of Optum Financial and exploring its growing importance to its parent company.

UnitedHealth Group’s foray into banking coincided with the 2003 Medicare Prescription Drug, Improvement, and Modernization Act, which established tax-advantaged HSAs to incentivize enrollment in high-deductible health plans. That same year, UnitedHealth Group founded Exante Bank – later renamed Optum Financial – and soon became the first company to offer both high-deductible health plans and HSAs, giving it an edge in the two burgeoning markets.

UnitedHealth Group profited by investing HSA deposits, earning more in dividends than it paid to accountholders in interest. And HSA deposits have since exploded, increasing from $3.2 billion in 2007 to $100.4 billion in 2024. Meanwhile, the HSA provider market has consolidated, with the “Big Four”– Fidelity, HealthEquity, Optum, and HSA Bank – now controlling roughly 70% of assets.

UnitedHealth Group also leveraged its vertically-integrated business model to expand Optum Financial beyond HSAs to “the only bank solely dedicated to health care,” according to a 2019 investor overview. For instance, in 2022, UnitedHealth Group paid $13 billion to acquire Change Healthcare, gaining access to the claims data of more than 900,000 doctors, among other providers, which it then used to target potential buyers of its financial products.

Then, in 2023 Optum Financial launched Optum Pay Advance, selling payday loans to physician practices. Unlike a typical bank, Optum Financial pocketed 35% of the total loan amount, and UnitedHealthcare – the company’s insurance arm – garnished the borrower’s claims reimbursements as a means of repayment.

Moreover, UnitedHealthcare denies claims at nearly twice the industry average rate, causing budget shortfalls for many practices. Practices, in turn, are less likely to qualify for a commercial loan from a traditional bank and thus more likely to seek out Optum Financial’s payday lending services.

Exploiting a crisis

Following the Change Healthcare cyberattack, Optum Financial extended no-interest emergency loans, which then-UnitedHealth Group CEO Andrew Witty told members of Congress would not come due until provider borrowers had indicated a full recovery. But, in early 2025, Optum Financial abruptly demanded full repayment within five business days, threatening to garnish providers’ claims payments if they didn’t comply, further compounding their financial losses as a result of the attack.

Sens. Elizabeth Warren (D-MA) and Ron Wyden (D-OR) raised concerns about these “abusive tactics to recoup funds” in an August 2025 letter to UnitedHealth Group. They are right to scrutinize Optum Financial, which Witty has said will be “a very, very material-scale business for us” in the coming decade.

But federal policymakers should also scrutinize their own role in enabling Optum Financial’s growth – including by creating the loophole that allowed UnitedHealth Group to start a bank, creating HSAs, and approving the Change Healthcare merger – at the expense of independent providers like Fruth Pharmacy. Fortunately, they can learn from their mistakes and enact reforms that would rein in Optum Financial, provide emergency relief to independent providers, and restore competition to the U.S. healthcare system.

The brief also recommends policy changes to protect independent providers from UnitedHealth Group, whose anticompetitive business practices increasingly drive them to close, sell, or borrow on unfair terms, driving healthcare costs up for everyone.

Such reforms could have saved Fruth from closure and its patients from being stranded in pharmacy deserts. “The [cyberattack] destroyed us,” Becker said. “And they offered nothing reasonable to make it right.”

You can read our paper here.