UnitedHealth Group, the largest U.S. healthcare insurer, is under investigation following allegations that it secretly paid nursing homes to reduce hospital transfers of residents under its Medicare Advantage plans. According to an investigation by The Guardian, the company embedded its medical staff in nearly 2,000 nursing homes and offered financial incentives such as “Premium Dividend” and “Shared Savings” to facilities that minimized hospital admissions. While the program aimed to cut costs, it allegedly led to delayed or denied emergency care, resulting in worsening patient outcomes, including permanent brain damage in some cases .The Guardian+1skillednursingnews.com+1
Internal documents and whistleblower testimonies revealed that nursing home staff were pressured to follow UnitedHealth’s protocols, often overriding medical necessity and patient preferences. Employees faced quotas and tracked metrics like “admits per thousand” to control expenses. UnitedHealth maintains that its measures improve patient outcomes, but critics argue that the practices prioritize profit over patient well-being and transparency.The Guardian
The controversy has had financial repercussions for UnitedHealth. The company’s stock dropped over 4% following the allegations, and it has faced other challenges, including missed earnings and CEO Andrew Witty’s resignation. Despite the company’s claims that the Department of Justice found the allegations factually inaccurate and chose not to pursue the case, investor confidence remains shaken .Reuters+2Investor’s Business Daily+2Investopedia+2Investopedia+2Reuters+2Investor’s Business Daily+2
The Department of Justice is reportedly investigating UnitedHealth for potential Medicare fraud, and whistleblowers have filed legal actions citing violations of the federal False Claims Act. The situation continues to evolve, with stakeholders closely monitoring the outcome of the investigations and the company’s response to the allegations.The Guardian+1Investopedia+1Investor’s Business Daily
