Why It Matters

Congressional investigations into Medicare Advantage billing practices, DOJ criminal probes, and bipartisan reform proposals like the No UPCODE Act directly target UnitedHealth Group’s core profit center. With MedPAC estimating $600 billion in MA overpayments from coding intensity alone, lawmakers are mobilizing to curb practices that benefit UHG’s bottom line.

The impending expiration of ACA premium subsidies threatens another major revenue stream—KFF projects marketplace premiums will more than double without congressional action, potentially destabilizing the 24 million-person market where UHG operates.

UHG’s stock has declined 44% in 2025 amid DOJ investigations, creating urgent pressure to influence legislative outcomes.

By the Numbers

UnitedHealth Group Inc. paid Avenue Solutions $90,000 for third quarter lobbying work, continuing a two-decade relationship. UHG has spent over $110 million on lobbying since 2003—$83.73 million through its in-house team and nearly $6.7 million through Avenue Solutions.

Avenue Solutions assigned three lobbyists: Tracy Birkhahn Spicer, former Deputy Policy Director for the Senate HELP Committee and Deputy Chief of Staff for Senator Ted Kennedy; Matthew C. Fuentes, who worked on Senate Finance Committee and as Legislative Aide to Majority Leader Chuck Schumer; and Aimee Lewis, who focuses on healthcare extenders.
This reflects a strategy aimed at shaping reform before unfavorable bills become law.

The Agenda

UHG is lobbying on two primary healthcare policy areas through Avenue Solutions.

Medicare Advantage Reforms dominate the company’s focus. UHG is advocating on S. 1105, the No UPCODE Act, which targets coding intensity and risk adjustment practices in MA plans. The company is also lobbying on broader MA issues including coding practices, benchmark adjustments, health risk assessments, and AI use in prior authorization decisions.

Expiring Healthcare Provisions represent the second major thrust. UHG is advocating for reauthorization of temporary healthcare programs and extension of the Affordable Care Act’s Enhanced Premium Tax Credits, which are set to expire.

Broader Context

Congress is intensifying scrutiny of Medicare Advantage payment practices. The Committee for a Responsible Federal Budget estimates MA will be overpaid by $1.2 trillion between 2025-2034, with MedPAC finding risk scores inflated by approximately 20 percent. A July 2025 House Ways and Means hearing revealed lawmakers concerned about $40 billion in MA billing overcharges.

Meanwhile, UnitedHealth disclosed DOJ criminal and civil investigations into its Medicare billing practices, creating existential pressure on the company’s $139 billion Medicare and retirement segment.

Between The Lines

The No UPCODE Act (S. 1105), a bipartisan bill co-sponsored by Senators Bill Cassidy (R-LA) and Jeff Merkley (D-OR), directly targets UHG’s core lobbying focus. H.R. 2433, the Reducing Medically Unnecessary Delays in Care Act, targets prior authorization abuses, while the Bipartisan Health Care Act (S. 891) addresses expiring ACA Enhanced Premium Tax Credits.

Representatives Lloyd Doggett (D-TX) and Greg Murphy (R-NC) called for independent investigations into MA organizations, while Senator Richard Blumenthal (D-CT) questioned insurers about AI-driven claims denials.

Competitive Landscape

Multiple major health insurers are simultaneously lobbying Congress on identical Medicare Advantage and ACA issues. AHIP is heavily engaged on MA rate notices and ACA premium tax credits. Kaiser Foundation Health Plan is lobbying on identical issues including MA rates and ACA subsidies.

Most notably, SCAN Health Plan’s filing explicitly mentions lobbying on S. 1105 (the No UPCODE Act) and MA issues including coding intensity and prior authorization—the precise same legislative targets as UHG.

The Bottom Line

UnitedHealth Group paid Avenue Solutions $90,000 to defend its Medicare Advantage business against mounting congressional pressure. The engagement targets the No UPCODE Act and advocates on expiring ACA premium tax credits. UHG deployed experienced Senate-connected lobbyists as part of an industry-wide advocacy effort against bipartisan MA reform.

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