US lawmakers are asking UnitedHealth Group, the nation’s largest healthcare conglomerate, to disclose internal documents about its efforts to reduce hospital transfers for nursing home residents and the bonuses it has given to nursing homes which help it to do so.
In a 6 August letter, the Democratic senators Ron Wyden and Elizabeth Warren asked UnitedHealth’s CEO, Stephen Hemsley, to hand over a trove of company records about a partnership program it has with nursing homes across the country, which aims to decrease hospitalizations and thereby coverage expenses for the conglomerate. The document demand letter follows a Guardian investigation into the initiative.
“Put simply, these allegations suggest that UHG [UnitedHealth Group] appears to be prioritizing its bottom line at the expense of the health and safety of nursing home residents enrolled in UHG I-SNPs,” Wyden and Warren wrote, referring to a type of UnitedHealth plan for long-term nursing home residents. “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.”
UnitedHealth argues the program is designed to curb “unnecessary” hospitalizations. The company has vigorously denied the allegations in the Guardian’s 21 May investigation, which was based on thousands of confidential corporate and patient records, public records requests and court files, interviews with more than 20 current and former UnitedHealth and nursing home employees, and two whistleblower declarations submitted to Congress in May through the non-profit legal group Whistleblower Aid.
“We stand firmly behind the integrity of our I-SNP program, which consistently receives high satisfaction ratings,” said a UnitedHealth Group company spokesperson. “The allegations stem from an article that misrepresents a program that provides high-quality care, personalized on-site clinical care and enhanced coordination among caregivers. The US Department of Justice extensively reviewed these allegations and found no evidence of wrongdoing.”
Wyden’s and Warren’s offices received a briefing from UnitedHealth on 29 July about the program. Both lawmakers, who sit on the powerful Senate finance committee, said they “remained concerned” about several aspects of the UnitedHealth nursing home initiative, according to the 6 August letter.
The senators pointed out, for example, that UnitedHealth pays some nursing homes bonuses based on their residents’ rate of hospital transfers, as the Guardian previously reported. But that bonus metric “does not take into account avoidable versus unavoidable hospitalizations, but rather sets a cap on hospitalizations for any reason, potentially making it a poor measure of quality of care”, the letter notes.
The company has previously said that its bonus payments to nursing homes help prevent unnecessary hospitalizations, which can be costly and dangerous, to patients and that its partnerships with nursing homes improve health outcomes.
Wyden and Warren are also seeking information about how the company markets its plans under Medicare Advantage, a privatized alternative to traditional Medicare, to nursing home residents, and about how its employees talk to residents about advanced care directives which can affect their ability to access hospital care. The senators are requesting information, too, on whether federal regulators have sanctioned certain UnitedHealth Medicare Advantage plans geared toward long-term nursing home residents within the last five years.
The healthcare conglomerate has faced lawsuits alleging its employees have improperly attempted to enroll nursing home residents into its Medicare Advantage plans and have risked or harmed residents’ health by helping to delay or avoid critical hospital transfers. Under Medicare Advantage, the federal government pays insurers fixed sums to cover the care of seniors, a model which critics contend can encourage inappropriate tactics to slash coverage expenses.
UnitedHealth has previously alleged that the Guardian’s reporting was “blatantly false and misleading” and said that the suggestion that its employees have prevented hospital transfers “is verifiably false”. UnitedHealth sued the Guardian for libel shortly after the outlet informed the company it was publishing a follow-up investigation into the nursing home program.
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The document demand letter from Wyden and Warren comes just a few months after lawmakers from both parties expressed rare bipartisan concern about UnitedHealth’s activities inside nursing homes.
In June, two congressional Democrats – representatives Alexandria Ocasio-Cortez of New York and Lloyd Doggett of Texas – sent a letter to the Department of Justice asking it to “thoroughly review new revelations from investigative reporting and whistleblower complaints, which suggest that UnitedHealth may have engaged in illegal activities”.
Likewise, Josh Hawley, a Missouri Republican on the Senate investigations subcommittee, vowed to secure “justice for patients, policyholders and whistleblowers alike who’ve been harmed by insurance companies”.
In their letter on Thursday, Wyden and Warren asked UnitedHealth to provide “a provide a full, written response” to their inquiry by 8 September.
In its statement, UnitedHealth said it would “continue to educate their staff and share information on the I-SNP model and its proven benefit for seniors”.
