UnitedHealth Under Investigation Over Nursing Home Resident Transfers

UnitedHealth has declined to share key internal records sought by lawmakers probing the company’s measures to cut down on transfers among nursing home residents. This information came to light through a letter addressed to the company from Senators Ron Wyden and Elizabeth Warren.

The investigation was initiated by the seasoned members of the Senate Finance Committee last summer, influenced by a Guardian report that scrutinized bonuses paid by UnitedHealth to nursing homes aimed at minimizing hospital transfers. Such transfers are costs that insurance companies, like UnitedHealth, must cover.

When asked for clarification on the senators’ claims regarding missing internal documents, UnitedHealth did not provide a direct response. Instead, they stated that their engagement with the senators is ongoing, claiming their nursing home care program “improves outcomes” while also reducing unnecessary hospital visits.

According to a recent letter from the senators, since their formal request five months ago, UnitedHealth has “refused” to release internal documents related to its hospitalization policies and bonus distributions, and has only offered “brief and unsubstantive answers” to the senators’ inquiries.

“Because of your inadequate response to our investigation, coupled with new reports, we are reopening the investigation with increased scrutiny,” wrote Wyden and Warren in a letter dated January 7.

This “additional recent reporting” refers to a December piece in the Guardian that detailed three alleged wrongful death incidents tied to UnitedHealth’s nursing home care program. This program allows staff from UnitedHealth’s medical segment, known as Optum, to tend to members of its insurance division, UnitedHealthcare.

In their statement, UnitedHealth firmly dismissed any suggestions that it jeopardizes patient safety or breaches ethical standards. “We proudly support the program that has delivered compliant and professional care to seniors in nursing homes for many years,” a spokesperson stated.

The letter sheds light on the ongoing investigation by Wyden and Warren into UnitedHealth’s practices. According to them, after a meeting with UnitedHealth on July 29, the company asserted that nursing homes in their program aren’t obligated to contact the company’s direct care division prior to hospitalizing residents.

However, Wyden and Warren countered this assertion, referencing company documents provided by a whistleblower that contradict this claim. Their letter indicates that UnitedHealth had encouraged nursing homes to reach out to the direct care division “immediately,” even in emergency situations.

Many of the senators’ questions remained “unresolved” post-meeting, and they pointed out that UnitedHealth “could not justify” using hospitalization rates as a metric for determining bonuses to nursing homes. As they noted before, these rates fail to differentiate between necessary and unnecessary admissions.

In their new letter, the senators reiterated their requests and set a deadline of January 28 for UnitedHealth to respond. “Failure to answer fully will compel us to seek alternative methods for acquiring answers to this critical investigation,” they wrote.

Under the Medicare Advantage program, insurance firms like UnitedHealth receive fixed payments from the federal government to cover the healthcare costs of long-term nursing home residents. The fewer hospital admissions they report, the more federal funds remain for other potential benefits.

As previously reported, UnitedHealth and its medical division, Optum, are facing legal challenges related to their nursing home initiatives.

In Ohio, a family has sued UnitedHealth, alleging negligence in the care of a retiree named Mary Grant. They claim that despite her head injury and vomiting, the nursing home and UnitedHealth failed to take her to the hospital, ultimately leading to her death.

The complaint argues that Optum’s nurses acted as “insurance adjusters” rather than independent medical professionals, ostensibly to withhold essential medical care from Grant.

In Georgia, a similar situation unfolded where the family of Cindy Diehl accuses nursing home staff and Optum of delaying hospital admission for her, resulting in her death following severe symptoms. The amended complaint claims that corporate policies prioritize profit over patient care.

UnitedHealth did not directly address inquiries regarding these specific lawsuits. Previously, the company has opted not to comment directly, citing patient privacy laws and ongoing litigation, but maintains that many allegations lack merit or are exaggerated.

UnitedHealth has previously rejected the legal claims from Grant and Diehl’s families. They emphasized their collaboration with nursing homes and medical professionals to ensure appropriate care for members, and noted high performance ratings from the National Quality Assurance Board.

In June, they even filed a defamation lawsuit against the Guardian stemming from reports about bonuses tied to reduced hospital transfers. This legal action marked yet another instance of the company attempting to silence criticism, according to reports from the New York Times.

Despite the lawsuit, the Guardian has stood by its reporting and continues to cover the practices surrounding UnitedHealth’s nursing home care.