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medicare advantage
Senate Dems Probe UnitedHealth Scheme to Slash Patient Care Costs at Nursing Homes
One whistleblower accused the giant corporation of "compelling medical professionals to comply with its financially-driven playbook at the expense of patient safety."
Aug 07, 2025
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.
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Why We Can't Simply Celebrate Medicare's 60th Birthday
Let's not allow President Trump and congressional Republicans to shred one of the greatest legacies of LBJ's Great Society.
Jul 30, 2025
Medicare turns 60 years old today. Former U.S. President Lyndon B. Johnson signed it into law on July 30, 1965, giving seniors a guarantee of health coverage that never existed before. Prior to Medicare's enactment, it was nearly impossible for older people to obtain health insurance, as they were considered a "bad risk."
Medicare provides universal coverage to Americans over 65 years of age. The law created Medicare Part A as a national hospital insurance program. Part B is a voluntary program for doctor visits and other medical services. Medicare Part C is another name for the privatized, for-profit version of the program called "Medicare Advantage." And Part D is the prescription drug program enacted in 2003.
The Hospital Insurance portion is funded through workers' payroll contributions. At the signing ceremony in Independence, Missouri, LBJ said, "Through this new law, every citizen will be able, in their productive years when they are earning, to insure themselves against the ravages of illness in his old age."
Lyndon Johnson paid tribute to former President Harry S. Truman, presenting him with the very first Medicare card. It was Truman who, 20 years earlier, had proposed a form of universal medical coverage for the American people.
LBJ quoted Truman's remarks from the 1940s:
Millions of our citizens do not now have a full measure of opportunity to achieve and to enjoy good health. Millions do not now have protection or security against the economic effects of sickness. And the time has now arrived for action to help them attain that opportunity and to help them get that protection.
It turned out that the time had not yet arrived. Truman's proposal failed to gain traction during a time of retrenchment from the expansions of the New Deal, and a Republican majority on Capitol Hill which he famously labeled the "Do-Nothing Congress."
President Johnson's determination to enact his Great Society agenda (of which Medicare was a large part) and sheer political muscle—not to mention solid Democratic control of Congress—pushed Medicare (and its sister program, Medicaid) into being.
Naturally, Medicare faced strong opposition from conservatives. None other than Ronald Reagan made the ludicrous prediction that if Medicare were enacted, "You and I are going to spend our sunset years telling our children and our children's children what it once was like in America when men were free." Sixty years later, we are no less "free" because of Medicare. In fact, having guaranteed healthcare makes seniors and people with disabilities (and their families) much more free—from disease, from worry, and financial ruin.
Today, 68 million people rely on Medicare for health coverage, including 12 million who are dually eligible for Medicare and Medicaid. Medicare isn't perfect: The for-profit Medicare Advantage (Part C) program is extremely problematic (see below). The Medicare Part A trust fund will become depleted in 2033 if Congress fails to take action to strengthen it. Traditional Medicare still doesn't cover basic hearing, vision, and dental care—which we have been pushing for many years. But most concerning of all—President Donald Trump and his party have spent this 60th anniversary year actively undermining both Medicare and Medicaid.
The "Unfair, Ugly" bill that Trump signed earlier this month slashed nearly $1 trillion from Medicaid, which will strip health coverage from an estimated 10 to 16 million lower-income Americans. The new law—projected to add some $4 trillion to the national debt—could trigger cuts to Medicare down the road.
Meanwhile, the Trump administration is recklessly taking steps to privatize the entire Medicare program. It has announced a pilot project to involve private companies in conducting prior authorizations for care in traditional Medicare. The administration, under Health and Human Services Secretary Robert F. Kennedy, Jr. and Centers for Medicare and Medicaid Services Director Mehmet Oz, also has announced a plan to automatically enroll new Medicare beneficiaries in the for-profit Medicare Advantage (MA) program—a huge gift to the multibillion dollar insurance industry at the expense of patients.
The problems with Medicare Advantage (MA) have become legendary. Enrollees are basically put into health maintenance organizations run by insurance giants, with limited networks of providers. Unreasonable denials of care are rampant. Patients who become disenchanted with MA plans often find it nearly impossible to switch to traditional Medicare. Meanwhile, some MA Insurers have been overcharging the government for their services and ripping off taxpayers. (Several of these companies are currently under investigation.)
We are watching to see if the Trump administration, which talks a good game about lowering prescription medication costs while simultaneously doing favors for Big Pharma, will honor the provisions of President Joe Biden's Inflation Reduction Act, which made myriad patient-friendly reforms to the Part D drug program—including out of pocket caps for beneficiaries and empowering Medicare to negotiate prices with the industry.
The bottom line is: Let's not allow President Trump and congressional Republicans to shred one of the greatest legacies of LBJ's Great Society. We and our fellow advocacy groups are pushing back—and so is the grassroots "Hands Off" movement. But we don't want to be fighting this same battle every time Medicare (and Medicaid) mark an anniversary when we should be purely celebrating.
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Report Highlights Threat Posed by 'Trump Health Cabal'
"Trump has nominated unqualified and dangerous people to serve in the most important health positions in the country," said Eagan Kemp, the author of the report for the consumer advocacy group Public Citizen.
Jul 30, 2025
The government watchdog group Public Citizen published a report on Tuesday warning that U.S. President Donald Trump's "dangerous health cabal threatens patients, providers, and the programs they rely on."
The report, written by healthcare policy advocate Eagan Kemp, takes aim at several of Trump's appointees to top healthcare posts. Among those highlighted are Secretary of Health and Human Services (HHS) Robert F. Kennedy Jr., Centers for Medicare and Medicaid Services (CMS) head Mehmet Oz, Deputy HHS Secretary Jim O'Neill, and surgeon general nominee Casey Means.
"The first few months of the Trump administration have brought chaos and disaster to an already fragmented and dysfunctional health care system," the report says. "From efforts to make massive cuts to the ACA and Medicare and layoffs of huge numbers of HHS staff across the agency, it is tough to keep up with all the damage being done."
Kennedy, the report says, has aggressively promoted "conspiracy theories and dangerous anti-science views" during his time as HHS secretary.
The report notes Kennedy's fear-mongering about the safety of the highly effective measles vaccine as the U.S. experienced the largest outbreak in recent years, and his purge of credentialed independent experts from the panel that makes national vaccine recommendations in favor of a clique of anti-vaccine activists.
The report also points to Kennedy's decision to de-emphasize research into infectious disease and prescription drugs and his mass firings at other agencies within HHS, including the Food and Drug Administration (FDA) and the National Institutes of Health (NIH).
"With Kennedy taking command of the HHS, Americans are presented lies and disinformation at an unprecedented scale that are capable of unwinding a century of progress on fighting disease and promoting public health," it says.
The report also highlights Oz's efforts to further privatize Medicare by championing Medicare Advantage, which it says "would leave more Americans at the whim of greedy health insurance corporations." It cites one study, which found that since 2007, overpayments to private Medicare providers added up to more than $600 billion, and could amount to another trillion over the next decade.
Additionally, the report cites findings from the Government Accountability Office (GAO) that patients with significant healthcare needs were more likely to drop Medicare Advantage in favor of returning to traditional Medicare, which it says "indicates that these patients were unable to receive necessary care" under the privatized program.
It describes Oz's "massive conflicts of interest," including his six-figure investments in Medicare Advantage providers like UnitedHealth and CVS Health.
"Medicare Advantage plans regularly deny needed care, making it difficult for low-resource hospitals to remain open to serve the public," the report says."If Oz gets his wish of further expanding Medicare Advantage, it will threaten the solvency of many hospitals, particularly rural hospitals currently at risk of closure, as they would struggle to keep their doors open because they wouldn't have the consistent funding they need to continue serving their communities."
O'Neill, who was appointed last month as Kennedy's deputy at HHS, is described as "a long-time venture capital investor with concerning views that reflect his significant financial ties to for-profit biomedical companies," adding that "his interests run counter to [HHS's] public health mandate."
The report notes O'Neill—a staunch libertarian—is opposed to FDA regulations to ensure the safety and efficacy of drugs, which he said "kill a lot of people and provide a lot of harm to the economy."
He has called to eliminate the agency's mandate to ensure that drugs are effective before they are approved for sale. In a 2014 speech to a biotech group, O'Neill said the FDA should "let people start using them, at their own risk."
As an official in the George W. Bush administration's HHS, he also opposed FDA regulations on diagnostic tests that rely on computer algorithms—an even more pressing issue today given the increasing ubiquity of artificial intelligence, including in healthcare.
"While he has a limited public record of comments on health issues broadly," the report says, "his dangerous and misinformed views about the workings of the FDA provide deep cause for concern that he will prioritize ideological and corporate profit considerations over the public health mandate of the department."
Means, Trump's pick for surgeon general—who would be the top authority on public health recommendations—is described as having "little to no managerial experience in the context of government agencies or scientific research."
She does not have an active medical license, and dropped out of her surgical residency. According to colleagues, she did so after coming to believe "that modern medicine is a conspiracy to keep people sick."
A "wellness influencer" in the mold of Kennedy, she has a history of anti-vaccine views and has advocated for getting rid of the Hepatitis B vaccination for babies, which is credited with reducing HBV infection by 68% over a decade after its introduction in 1991. Means has also said that birth control pills are overprescribed, and that they signal a "disrespect of life."
She also stands to potentially profit from her decisions as surgeon general, the report says, since she remains the chief medical officer of a glucose monitoring technology company and has not stepped down from her post despite the possible conflicts of interest.
"The range of unscientific ideas, wellness products, and conspiratorial claims that Means is associated with," the report says, "makes her a potentially dangerous person to serve in a role that requires being a credible health communicator for the country and upholding sound science."
The state of healthcare in the United States, the report says, is about to become more precarious following the passage of the "One Big Beautiful Bill Act," which is projected to result in 10 million people losing their health insurance. Medicare privatization has also accelerated, with hiked rates for Medicare Advantage plans.
"The fact that Trump, Kennedy, and their allies have taken so many dangerous and misguided actions on health in just the early months of the new administration," the report says, "highlights the need for vigilance and strong pushback from anyone who wants a better healthcare system."
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