Report: UnitedHealth Paid Nursing Homes to Keep Patients Out of Hospital

UnitedHealth Group, the healthcare conglomerate facing a criminal investigation over possible Medicare fraud, secretly paid nursing homes thousands of dollars in bonuses to cut hospital transfers for ailing residents, risking patient health while it saved millions, per a Guardian investigation. The outlet identified numerous cases where nursing home residents needed immediate hospital care but failed to receive it after UnitedHealth's intervention. In one 2019 case out of Washington state, a nursing home resident was showing textbook symptoms of a stroke, indicating immediate hospitalization was needed. But a remote UnitedHealth employee wanted a less-serious condition ruled out first and asked for an update in, not minutes, but four hours.

In a similar case that year, a remote UnitedHealth employee delayed requesting a hospital transfer for a patient with stroke symptoms, forcing facility nurses to bypass the system. It took an hour and the patient suffered permanent brain damage, per the Guardian. Other UnitedHealth nurses say they faced pressure to persuade Medicare Advantage members to adopt "do not resuscitate" orders—an effort to prevent costly hospital stays—even when the patients had expressed a desire to seek all available treatments.

"A lot of times the [facility] nurses want to send people out and we have to go in and try to stop it," a UnitedHealth nurse tells the outlet. "And if we don't ... they take us out onto the carpet." "The sense is: 'Well, they're medically frail, and no one lives for ever,'" says another nurse. "No one is truly investigating when a patient suffers harm." Though internal emails reference "budgets" outlining how many hospital admissions a nursing home had "left," UnitedHealth denies that its employees prevented hospital transfers or inappropriately pushed patients to change their DNR status. It says nursing homes receive bonuses for preventing unnecessary hospitalizations that are harmful to patients. The company's shares fell almost 7% Wednesday following the report, per Reuters. (More UnitedHealth stories.)