A UnitedHealth Group program allegedly incentivized nursing homes to avert medically necessary hospital transfers for their residents, according to an investigation by The Guardian.
The program places UnitedHealth employees at about 2,200 nursing homes across the country. The Guardian reported these nursing homes were secretly paid thousands in bonuses to prevent transferring residents to hospitals — which was part of a strategy that saved the company millions while risking patient safety.
UnitedHealth Group, the nation’s largest insurer, by membership, refuted the claims.
“The U.S. Department of Justice investigated these allegations, interviewed witnesses and obtained thousands of documents that demonstrated the significant factual inaccuracies in the allegations,” UnitedHealth Group said in a statement responding to the report. “After reviewing all the evidence during its multi-year investigation, the Department of Justice declined to pursue the matter.”
The Guardian reviewed thousands of confidential corporate and patient records, and interviewed more than 20 current and former UnitedHealth and nursing home employees. The report also included two whistleblower complaints filed in May.
The report alleges that UnitedHealth staff intervened in potential transfers to improve their “admits per thousands,” or APK, measure, which is the rate of nursing home residents being transferred to hospitals. A low APK led to bonus payments, a high APK resulted in nothing, according to The Guardian.
An internal email allegedly showed that UnitedHealth supervisors had “budgets” on how many hospital admissions “left” for nursing home residents, the report said. Other payments seemed to press nursing homes to share confidential patient information with UnitedHealth so the insurer “could directly solicit elderly residents and their families,” a whistleblower lawsuit alleges.
The payer told The Guardian these bonuses aim to prevent unnecessary and costly transfers, incentivize high-quality outcomes and reward improved care efforts.
UnitedHealth allegedly also tracked nursing homes with a small number of “do not resuscitate” and “do not intubate” orders and pushed nurse practitioners to persuade Medicare Advantage members to change their status to DNR, since patients without this order might lead to expensive hospital bills.
UnitedHealth denied this allegation as well. Read more here.
