Two prominent US senators have accused the healthcare giant UnitedHealth of failing to hand over crucial internal documents as part of an investigation into its nursing home care practices. The inquiry, launched last summer, scrutinises financial incentives the company offers to care homes for reducing hospital transfers for residents.
Senators Escalate Demands for Transparency
In a letter dated 7 January, Senators Ron Wyden and Elizabeth Warren, both senior members of the Senate Finance Committee, expressed "heightened alarm" at UnitedHealth's lack of cooperation. The lawmakers stated that over five months, the company had "declined to produce" any internal records concerning its hospitalisation policies or bonus payments to nursing homes.
UnitedHealth, which owns both the insurance provider UnitedHealthcare and the medical services group Optum, runs a programme where Optum staff care for residents insured by its own insurance arm. The senators' investigation was prompted by a Guardian report revealing that UnitedHealth pays bonuses to nursing homes that cut down on hospital admissions—costs the insurer would otherwise have to cover.
In response to the senators' allegations, a UnitedHealth spokesperson said the company would "continue to engage" with lawmakers and defended its programme, claiming it "improves outcomes" and "reduces unnecessary hospitalisations." The company did not directly address the specific claim about withholding documents.
Whistleblower Evidence and Wrongful Death Allegations
The senators' letter provides new details of their probe. It reveals that during a briefing on 29 July, UnitedHealth told Senate staff that nursing homes in its scheme were not required to consult with its direct care division before sending a resident to hospital. However, Wyden and Warren contend this claim "is at odds" with an internal company document provided by a whistleblower.
That document allegedly instructed nursing homes to "immediately" call UnitedHealth's direct care team, even when a resident needed urgent hospital transfer. The letter also states UnitedHealth was "unable to justify" its use of hospital admission rates as a metric for bonus payments, a practice critics say fails to distinguish between necessary and unnecessary care.
The senators' renewed urgency follows a December Guardian report detailing allegations linking UnitedHealth's programme to three wrongful deaths. In one case, the family of 70-year-old Mary Grant from Ohio is suing, alleging she died after her nursing home and an Optum nurse practitioner failed to send her to hospital following a traumatic head injury. The lawsuit claims the practitioner acted as "an insurance adjuster" to deny necessary care.
In a separate Georgia case, the family of Cindy Deal alleges the 58-year-old died after her nursing home and Optum staff delayed hospitalisation for hours while she was foaming at the mouth and having a seizure. A legal complaint alleges corporate policies aimed at boosting profits led to a block on "life-saving care."
UnitedHealth has previously declined to comment on specific cases, citing patient privacy and ongoing litigation, but has stated many claims are unsubstantiated. The company has denied the families' allegations in court.
Profit Model Under Scrutiny
The controversy centres on the financial structure of Medicare Advantage, the US government programme under which UnitedHealth operates. Insurers receive fixed federal payments to cover the medical costs of nursing home residents. The fewer hospitalisations an insurer pays for, the more of that government money it can retain as profit.
Wyden and Warren have given UnitedHealth a new deadline of 28 January to comply fully with their document requests, warning they will "pursue answers... by other policy means" if the company fails to respond. This investigation adds to existing legal challenges for UnitedHealth and Optum, which are facing lawsuits related to their nursing home programme.
In a notable move last June, UnitedHealth sued the Guardian for defamation over its original reporting on the bonus payments. The Guardian has stood by its reporting and continued to cover the story.
