The 12 months since UnitedHealthcare CEO Brian Thompson was fatally shot have been among the most turbulent in UnitedHealth Group’s history. The company has cycled through senior executives, disclosed billions in unexpected medical costs, confirmed it is under criminal investigation by the Justice Department, and watched its stock plunge by around 50%. Here’s where things stand as the year comes to a close.
One year later
One year after Brian Thompson was shot and killed outside a Manhattan hotel, the man charged in his death remains in pretrial proceedings with no trial date set.
Luigi Mangione, 27, appeared in New York state court in early December for hearings that could determine which evidence jurors see at trial.
New York City police called the shooting a “brazen and targeted attack,” and shell casings found at the scene were inscribed with the words “delay,” “deny” and “depose.”
Mangione has pleaded not guilty to nine state charges, including second-degree murder, and four federal charges that carry the possibility of the death penalty. A judge dismissed two state terrorism charges in September, ruling the evidence failed to establish Mangione committed the crime to coerce civilians or influence government policy.
The 2024 killing sparked a polarized public response and led to a firestorm of online hostility toward the health insurance industry more broadly. An Emerson College poll found 68% of respondents deemed the killing unacceptable, while 17% found it acceptable. Among voters aged 18 to 29, the split was nearly even: 41% acceptable, 40% unacceptable. A separate NORC survey found nearly 70% of respondents said claims denials and insurer profits bear a “great deal” or “moderate amount” of responsibility.
Insurers across the industry increased executive security spending in response. UnitedHealth Group disclosed $1.7 million in security costs for top executives in 2024. CVS Health, Elevance Health and Centene reported similar measures. The shooting also triggered threats against other healthcare organizations.
Former UnitedHealth CEO Andrew Witty published an op-ed in The New York Times shortly after the killing, expressing sympathy with public frustrations over the “flawed” healthcare system. The CEO of another insurer called on the industry to rebuild trust with the wider public, writing: “We are sorry, and we can and will be better.”
Mr. Thompson’s death also forced a public reckoning over prior authorization. In June, nearly 50 insurers, including UnitedHealthcare, Aetna, Cigna and Humana, signed a voluntary pledge to streamline prior authorization processes, reduce the number of procedures requiring authorization and ensure all clinical denials are reviewed by medical professionals.
While insurers have made similar promises in the past, CMS Administrator Mehmet Oz, MD, said during the announcement that the difference this time is “there’s violence in the streets over these issues.”
Internal recalibration
UnitedHealth spent much of 2025 in damage-control mode, working to stabilize its finances and restore investor confidence after a series of operational missteps.
The turbulence began in the first quarter, when the company reported during its April earnings call that it was caught off guard by Medicare Advantage utilization rates twice as high as expected, along with performance issues within its sprawling Optum Health business. The surprise led UnitedHealth to cut its 2025 earnings guidance, and then-CEO Andrew Witty called the earnings report “frankly unusual and unacceptable.” The company’s stock dropped more than 20% in a single day.
In May, Mr. Witty stepped down. He was replaced by Stephen Hemsley, the company’s board chair who previously served as CEO from 2006 to 2017. The company has named several other senior leaders in recent months.
“We are well aware we have not fulfilled your expectations or our own,” Mr. Hemsley told investors in June. “We apologize for that performance and we are humbly determined to earn back your trust and your confidence.”
UnitedHealth now expects $6.5 billion more in medical costs for 2025 than originally anticipated, with $3.6 billion of that within the Medicare business and $2.3 billion in the commercial business. Optum Health, the care delivery unit, is facing an $11 billion headwind over three years, with $7 billion occurring in 2025. The company posted a $2.3 billion profit in the third quarter of 2025, down from a $6.1 billion profit during the same time last year.
In response, UnitedHealthcare is discontinuing some MA plans and expects total MA membership to decline by up to 1 million during the current open enrollment period. Optum Health is dropping about 200,000 PPO lives as it shifts back to its core value-based care model.
“Having competed against this organization for years, the one thing that’s very clear to me is that the assets are as good as I thought they were,” CFO Wayne DeVeydt said in November. “We want to show that we can get back to the swagger the company once had.”
The company is projecting a 10% medical cost trend for 2026, up from 7.5% in 2025. Within its ACA business, UnitedHealthcare is implementing a 25% rate increase and expects to lose two-thirds of its exchange membership if enhanced premium subsidies expire at year-end.
UnitedHealth is also investing heavily in AI, deploying more than 2,000 engineers and integrating over 1,000 use cases across its business. Optum has rolled out AI-enabled products to hospitals and other providers, including a multi-payer claims solution and predictive analytics tools for operating room scheduling, as it works to regain customers lost after the 2024 Change Healthcare cyberattack.
The company plans to resume share buybacks in the second half of 2026 and return to its normal M&A activity, with margin expansion expected in 2027.
Other headwinds
Beyond its financial struggles, UnitedHealth has spent the year contending with fallout from last year’s Change Healthcare cyberattack and multiple federal investigations into its business practices.
The February 2024 ransomware attack on Change, a claims processing subsidiary that handles an estimated 1 in 3 U.S. healthcare transactions, left providers unable to process claims and prescriptions for weeks. The company has since increased its estimate of affected individuals to nearly 193 million.
The attack also cost UnitedHealth significant business, with CFO Wayne DeVeydt acknowledging in November that healthcare companies moved away from Change after the breach.
“A lot of payers realized, as well as providers, that having all your eggs in one basket wasn’t a good thing,” Mr. DeVeydt said. “We had to rebuild trust with our existing customer base and get new products to market.”
Nebraska, along with insurers, has sued Change Healthcare and UnitedHealth over the breach, alleging violations of consumer protection and data security laws. A judge denied the companies’ motion to dismiss the case in November, allowing it to proceed.
Separately, the Justice Department has been conducting criminal and civil investigations into UnitedHealth’s MA billing and coding practices. In July, UnitedHealth disclosed it is complying with formal requests from the DOJ after initially saying it had not been notified of any investigation. The criminal probe has since expanded to examine how Optum Rx compensates its employed physicians, Bloomberg reported in August. Since the summer, the DOJ has been quiet on the issue and no major updates have occurred publicly.
UnitedHealth has said it “has a long record of responsible conduct and effective compliance” and is “committed to maintaining the integrity of its business practices.”
M&A continues
While UnitedHealth has said it plans to ramp up M&A activity in 2026, the company never stopped acquiring other healthcare companies this year.
In August, UnitedHealth closed its long-delayed acquisition of home health and hospice provider Amedisys after reaching a settlement with the DOJ and four states. The deal, originally announced in 2023, required the divestiture of home health and hospice clinics across 19 states to resolve antitrust concerns. Combined with its 2023 acquisition of LHC Group, UnitedHealth is now likely the largest hospice provider in the country.
Earlier in 2025, Optum quietly acquired one of the largest gastroenterology physician groups in the country, along with a 200-provider group in Tennessee. The scope of UnitedHealth’s acquisition strategy came into sharper focus in July with the release of a first-of-its-kind report that detailed the company’s purchasing history. The report found that as of late 2024, UnitedHealth was composed of 2,694 subsidiaries, with most acquisitions occurring since 2010. The company owns the country’s largest health insurer, employs or has contractual ties with more than 90,000 physicians, and controls 21% of the PBM market.
