A Guardian investigation has revealed that UnitedHealth Group, the largest healthcare conglomerate in the United States, secretly paid nursing homes thousands of dollars in bonuses to reduce hospital transfers for frail residents. The cost-cutting tactics have saved the company millions but at times risked residents' health, according to confidential records and whistleblower accounts.
The secret bonuses were part of a program where UnitedHealth stations its own medical teams in nursing homes to cut care expenses for Medicare Advantage enrollees. Internal documents and interviews with over 20 current and former employees indicate that in several cases, residents who needed immediate hospital care failed to receive it after interventions from UnitedHealth staff. One resident suffered permanent brain damage following a delayed transfer.
UnitedHealth offered financial incentives such as 'Premium Dividend' and 'Shared Savings' payments to nursing homes that maintained low hospital admission rates. The metric 'admits per thousand' (APK) determined eligibility for bonuses, with a low APK qualifying homes for payments and a high APK resulting in no bonus. A former executive stated that 'APK drove everything' and that profitability was gained by denying care.
The company denied the allegations, stating that suggestions its employees prevented hospital transfers are 'verifiably false'. It maintained that the bonus payments help prevent unnecessary hospitalizations and improve health outcomes. The investigation comes amid public scrutiny of UnitedHealth following the fatal shooting of a top executive in December.
