Senate Dems Investigate UnitedHealth Scheme to Slash Patient Care Costs at Nursing Homes

A pair of Democratic senators on Thursday launched an investigation into the most powerful corporation in the U.S. healthcare system, sounding alarm over allegations that UnitedHealth Group is incentivizing nursing homes to slash care expenses for patients insured by the company.

Sens. Ron Wyden (D-Ore.) and Elizabeth Warren (D-Mass.) wrote in a new letter to the company's CEO that UnitedHealth Group (UHG) has "been at the center of numerous reports suggesting that it is maximizing profits at the expense of patients' health and well-being," including accusations that the company "systematically denied needed care to children and adults with chronic illnesses" and used an artificial intelligence algorithm to deny Medicare Advantage enrollees necessary care.

Most recently, the senators noted, reporting by The Guardian alleged that UnitedHealth is using a bonus scheme to push nursing homes that contract with Optum to reduce hospital transfers as part of an aggressive cost-cutting effort. Optum is a UHG subsidiary that employs or affiliates with roughly 10% of all physicians in the U.S.

Wyden and Warren demanded that UnitedHealth provide answers to numerous questions related to its practices at nursing homes, including whether it institutes "hospital transfer quotas" at the facilities it works with.

"UHG denies the allegations in The Guardian's reporting and maintains that its practices reflect best practices in the care of nursing home residents," the senators wrote. "However, we are concerned that the methods UHG appears to rely on to deliver the high-quality care it purports to provide may in fact incentivize practices that threaten resident safety."

"I'd like to see them held accountable for putting profits over patients."

The Guardian's reporting underscores the extent to which UHG has injected itself into virtually every aspect of the American healthcare system. The healthcare conglomerate has roughly 2,700 subsidiaries, according to an analysis by the Center for Health and Democracy.

Using confidential corporate and patient records, whistleblower accounts, and interviews with UHG staffers and nursing home employees, The Guardian examined a company program under which Optum medical teams provide care on-site at nursing homes or in partnership with facility staff.

The newspaper identified "several cases" in which "nursing home residents who needed immediate hospital care under the program failed to receive it, after interventions from UnitedHealth staffers."

"At least one lived with permanent brain damage following his delayed transfer, according to a confidential nursing home incident log, recordings, and photo evidence," the newspaper reported. "To reduce residents' hospital visits, UnitedHealth has offered nursing homes an array of financial sweeteners that sounded more like they came from stockbrokers than medical professionals."

The company also allegedly gave its medical teams "budgets" limiting the number of hospital admissions they could allow for nursing home patients.

One whistleblower, a nurse practitioner formerly employed by a UnitedHealth insurance subsidiary, said in a statement that "scores of elderly patients may never have received the care that they needed, all because UnitedHealthcare skimped on care to cut costs."

“UnitedHealthcare is compelling medical professionals to comply with its financially-driven playbook at the expense of patient safety in a way that pressures providers to violate their ethical obligations," the whistleblower added. "I'd like to see them held accountable for putting profits over patients."

UnitedHealth raked in over $34 billion in profits last year—far more than any other U.S. healthcare company.

Wendell Potter, a former Cigna executive who now serves as president of the Center for Health and Democracy, wrote in a recent blog post that mounting scrutiny of UHG's practices shows the company is "facing a reckoning it can't ignore."

"It's coming from every direction: the U.S. Department of Justice (under President Donald J. Trump), congressional Republicans and Democrats, state lawmakers and regulators, the media, physicians, hospital administrators, tens of thousands of Americans on the internet sharing their own personal UnitedHealth horror stories, and, most importantly for the C-Suite, enraged investors who've lost hundreds of billions of dollars in recent months," Potter wrote.