Senators Elizabeth Warren and Ron Wyden are ramping up their examination into UnitedHealth Group’s nursing home initiatives due to insufficient responses from the company to their initial inquiries, coupled with new allegations of patient fatalities. An escalated tone marked their Jan. 7 follow-up letter sent to UnitedHealth Group CEO, Stephen Hemsley, after the company’s perceived lack of substantive response to the senators’ initial request for information in August. The senators are wielding the power of the Committee to warn UnitedHealth of possible actions if they fail to respond adequately to this pressing inquiry.
This intensified investigation follows the December reports provided by The Guardian, which shed light on three separate incidents where nursing home residents purportedly died due to delayed or declined hospital transfers as a result of Optum’s actions. One of these instances involves a legal claim indicating a 70-year-old woman’s unfortunate demise following an Optum’s plan to keep her at the nursing home against professional suggestions for hospital transfer. She has shown signs of deteriorating health such as vomiting and low oxygen levels after suffering a head injury from a fall the day before.
The initial scrutiny by the senators was prompted after a Guardian report in May levied accusations against UnitedHealth for allegedly encouraging nursing homes across the country to avoid medically required hospital transfers for its member residents for cost considerations. While UnitedHealth has vehemently denied these allegations – even pursuing defamation against The Guardian – the senators are unsatisfied.
In their latest correspondences, the senators expressed dissatisfaction with UnitedHealth’s response to their initial inquiry. They pointed out that the company provided concise answers, but failed to include crucial documentation pertaining to hospitalization policies, bonus schemes, or a list of their nursing home contracts. The senators also picked up on inconsistencies between the information provided by UnitedHealth in a July briefing and incriminating whistleblower documents they now possess. For instance, while UnitedHealth stated that nursing homes don’t have an obligation to inform Optum before initiating resident transfers to hospitals, the senators highlighted a 2019 internal document in their possession that directs facilities to inform Optum, even in emergency patient transfer situations.
The senators also questioned UnitedHealth’s alleged usage of the ‘all-cause hospital admissions per thousand members’ (APK) as a determinant for bonus payments to nursing homes. The lawmakers referred to a whistleblower document that mentioned an ‘APK budget’ that was expected for nursing homes to adhere to. As a result, they requested additional information to clarify these points.
A company representative assured ongoing engagement with Senators Warren and Wyden and their staff, rejecting any insinuation that UnitedHealth Group or Optum participate in practices that jeopardize patient safety or breach ethical norms. UnitedHealth further emphasized their commitment to improving patient outcomes, reducing unnecessary hospitalizations, and always prioritizing the health, safety, and dignity of their patients.