Dive Brief:
- Two influential Democrat senators are investigating UnitedHealth over reports that the healthcare behemoth may be restricting care for nursing home residents in order to profit.
- On Wednesday, Sens. Ron Wyden, D-Ore., and Elizabeth Warren, D-Mass., sent a letter to UnitedHealth requesting more information after a briefing the company gave lawmakers on the issue late last month failed to assuage their concerns.
- The letter requests more information on UnitedHealth's hospitalization policies, advance directive planning, marketing strategies, and state and federal oversight of its plans.
Dive Insight:
In May, the Guardian published a bombshell investigation finding that UnitedHealth paid nursing homes lucrative bonuses if they reduced hospital transfers for residents in UnitedHealth insurance plans. Such arrangements are meant to prevent unnecessary hospitalizations by improving upstream care — but when kicked into overdrive can serve as a source of profits for insurers by paring back expensive inpatient claims.
UnitedHealth vehemently denied the Guardian’s reporting and sued the outlet for defamation.
Still, Wyden and Warren called the report “alarming” in their letter, and requested more information on UnitedHealth’s institutional special needs plans, or I-SNPs: Medicare Advantage coverage for people dually eligible for Medicare and Medicaid living in skilled nursing facilities.
“We have outstanding questions about how [UnitedHealth’s] programs are structured and their effects on patient safety,” the two senators wrote.
The company’s “incentive schemes may drive delays in medically-necessary hospitalizations and emergency room visits, poor health care outcomes, and even permanent harm among enrolled residents who suffer strokes and other major health events without being hospitalized,” Wyden and Warren said in the letter, adding that reporting also alleges that Optum pushed residents to sign orders that they not be resuscitated or intubated — steps that may hasten death but prevent hospitalization.
“Put simply, these allegations suggest that [UnitedHealth] appears to be prioritizing its bottom line at the expense of the health and safety of nursing home residents enrolled in [UnitedHealth I-SNPs]. Nursing home residents and their families should not live in fear of a for-profit health care company withholding care when it is most critical,” the letter reads.
The senators gave UnitedHealth until September 8 to respond to their list of roughly 50 questions.
UnitedHealth did not respond to a request for comment.
UnitedHealth — which operates the largest private insurer in the U.S., along with a major pharmacy benefit manager, large physician network and a bevy of other businesses — has found itself at the center of a maelstrom of public discontent over health insurers’ business practices that restrict care. UnitedHealth is also facing lawmaker and regulatory scrutiny into how it may be preventing competition in healthcare markets, leveraging algorithms to restrict care and gaming federal healthcare programs to bring in higher reimbursement.
The Department of Justice is currently investigating UnitedHealth for potential billing fraud in MA.
The company has also been struggling financially, electing to pull its earnings guidance and replacing its CEO earlier this year. UnitedHealth reestablished a much lower floor for 2025 profits in July, saying that it had seriously underestimated medical costs in its plans this year.
