Critical care was sometimes delayed and patients were harmed, whistleblowers asllege
- A Guardian investigation reveals UnitedHealth paid bonuses to nursing homes to reduce costly hospital transfersallegedly at residents' expense.
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Whistleblowers and internal records point to instances where critical care was delayed, resulting in serious harm, including permanent brain damage.
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Tactics included pressuring patients to sign DNR orders and incentivizing staff to leak patient records for Medicare Advantage enrollments.
UnitedHealth Group, the nations largest healthcare conglomerate, secretly paid nursing homes thousands in bonuses to reduce hospital transfers for frail residentstactics that saved the company millions of dollars but may have endangered patient lives, according to a Guardian investigation supported by whistleblower testimony, leaked documents, and internal recordings.
The incentives were part of a UnitedHealth program that embeds its own medical teams in nearly 2,000 nursing homes nationwide. These teams were reportedly tasked with lowering healthcare spending for patients enrolled in UnitedHealths Medicare Advantage plans, in part by minimizing costly hospital admissionseven when emergency care was urgently needed.
In onecase, a resident suffered permanent brain damage after a hospital transfer was allegedly delayed under UnitedHealths cost-cutting protocols, the Guardian reported, citing documented records. Whistleblowers have since submitted complaints to Congress through the nonprofit Whistleblower Aid, alleging systemic neglect and concealed harm to seniors.
No one is truly investigating when a patient suffers harm. Absolutely no one, said a UnitedHealth nurse practitioner who filed a congressional complaint.
"APK drove everything"
Under Medicare Advantage, insurers receive a fixed sum per patient from the federal government. If they spend less than that on care, the remainder becomes profit. To maximize those margins, UnitedHealth has reportedly prioritized reducing admits per thousand (APK)a key internal metric that measures how often patients are hospitalized.
Nursing homes that kept their APKs low earned Premium Dividend and Shared Savings payouts. Others were enrolled in a Quality and Shared Risk program, which offered even bigger bonusesbut clawed back funds if spending exceeded targets, the newspaper reported. Documents reviewed by The Guardianallegedly reveal that UnitedHealth executives obsessively monitored APKs and issued budgets for hospital admissions.
You gain profitability by denying care, said one former executive. When profitability suffers... thats when people get crazy and do things that are not appropriate.
DNR pressure and alleged record leaks
Former UnitedHealth employees also say they were pressured to persuade patients to accept "do not resuscitate" (DNR) and "do not intubate" orderseven when those preferences contradicted patients expressed wishes. By reducing life-saving interventions, these orders lower the likelihood of costly hospital stays.
Meanwhile, whistleblower lawsuits and interviews quoted by the Guardian indicate that UnitedHealth sales staff solicited confidential patient records from nursing home employees to boost enrollment in its Institutional Special Needs Plans (ISNPs)insurance plans for long-term nursing home residents.
One ex-employee in Georgia admitted she backdated consent forms to bypass federal rules designed to protect elderly patients from aggressive marketing. In another case near Savannah, families claimed that relatives with cognitive impairments were enrolled without valid consent, raising further questions about the legality of UnitedHealths outreach practices.
UnitedHealth Denies Allegations
UnitedHealth has denied preventing necessary hospital transfers or coercing patients into changing their medical directives. The company maintains that its nursing home initiative improves care through on-site clinical support, personalized treatment plans, and stronger family communication.
Our partnerships with nursing homes improve health outcomes, the company said in a statement.
Federal Scrutiny Mounts
The investigation comes at a time of growing scrutiny for UnitedHealth. The U.S. Justice Department recently launched a civil fraud probe into the company, and public backlash has intensified following the December 2024 murder of a UnitedHealth executivean incident that reignited outrage over the companys Medicare operations and patient care decisions.
As federal investigations continue, whistleblowers and advocates are urging lawmakers to confront what they call a systemic profit-first strategy that sacrifices patient well-being for shareholder returns.
This isnt just about cutting costsits about who gets to decide whether someone lives or dies, said one former nurse practitioner.
UnitedHealth, valued at more than $300 billion, remains a dominant force in Medicare Advantage. But this expos adds to the growing body of evidence that the companys business model may be fundamentally incompatible with quality care for the nations most vulnerable patients.
Posted: 2025-05-21 14:24:08
