contract negotiation; contracts may be discontinued from time to time. High-profile contract disputes can span provider networks across the nation, as in the case of a 2018 dispute with a major emergency room doctor group, Envision Healthcare. Provider directory Maintaining up-to-date provider directories is necessary since the Centers for Medicare and Medicaid Services can fine insurers with outdated directories. As a condition of participation, UnitedHealthcare requires that providers notify them of changes, but also has a Professional Verification Outreach program to proactively request information from providers. However, providers are burdened by having to maintain their information with multiple networks (e.g., competitors to UnitedHealthcare). The total cost of maintaining these directories is estimated at $2.1b annually, and a blockchain initiative began in 2018 to share the directory. Finance For the fiscal year 2020, UnitedHealth Group reported earnings of US$15.40 billion, with an annual revenue of US$257.1 billion. Criticism and controversies Lobbying In 2009, according to OpenSecrets, people affiliated with UnitedHealth Group gave a record of $5.52 million to political candidates and groups. The Affordable Care Act was being discussed in Congress at the time. The Affordable Care Act was subsequently passed in the first quarter of 2010. UnitedHealth Group subsequently spent $2.75 million to $4.86 million from 2011 to 2021 and the company went on to pull in $78,692 million in revenue in the fourth quarter of 2021 alone. The UnitedHealth Group hired seven different lobbying firms to work on its behalf in 2010. In addition, its corporate political action committee or PAC, called United for Health, spent an additional $1 million on lobbying activities in 2010. QSSI, a subsidiary of UnitedHealth Group, is one of the 55 contractors hired by United States Department of Health and Human Services to work on the HealthCare.gov web site. Legal issues In 2006, the U.S. Securities and Exchange Commission (SEC) began investigating the conduct of UnitedHealth Group's management and directors, for backdating of stock options. Investigations were also begun by the Internal Revenue Service and prosecutors in the U.S. attorney's office for the Southern District of New York, who subpoenaed documents from the company. The investigations came to light after a series of probing stories in the Wall Street Journal in May 2006, discussing apparent backdating of hundreds of millions of dollars' worth of stock options by UHC management. The backdating apparently occurred with the knowledge and approval of the directors, according to the