Senators Elizabeth Warren, D-Mass., and Ron Wyden, D-Ore., are expanding their probe into UnitedHealth Group’s nursing home programs after the company provided what they said is an insufficient response to their initial inquiry, along with new allegations of resident deaths.
In a Jan. 7 follow-up letter to UnitedHealth Group CEO Stephen Hemsley, the senators wrote they are renewing their inquiry “with heightened alarm” after the company failed to meaningfully respond to their initial request for information in August. The letter warns that if UnitedHealth fails to fully respond, the senators “will pursue answers to this critical inquiry using all tools at the Committee’s disposal.”
The intensified probe follows December reporting by The Guardian that detailed three cases in which nursing home residents allegedly died after Optum delayed or denied hospital transfers. One wrongful death lawsuit claims a 70-year-old woman died after an Optum employee coordinated a plan to treat her at the nursing home rather than transfer her to a hospital, despite vomiting and low oxygen levels following a head injury from a fall the previous day.
The senators’ original investigation came after a Guardian report in May accused UnitedHealth of incentivizing nursing homes nationwide to avoid medically necessary hospital transfers for its member residents. UnitedHealth has denied the allegations and sued The Guardian for defamation in June, calling the report “unquestionably defamatory.”
In their latest letter, the senators said UnitedHealth’s response to their first inquiry provided brief answers but failed to include requested documentation about hospitalization policies, bonus programs or a list of contracted nursing homes.
The senators also cited discrepancies between information UnitedHealth provided in a July briefing and whistleblower documents in their possession. For example, UnitedHealth told Senate staff that nursing homes aren’t required to contact Optum before transferring residents to hospitals. The senators pointed to a 2019 internal document instructing facilities to call Optum “even if they are sending a member out urgently.”
The senators are also questioning UnitedHealth’s reported use of all-cause hospital admissions per thousand members (APK) as a metric for bonus payments to nursing homes, noting that a whistleblower document references an “APK budget” that nursing homes were expected to maintain.
The senators are requesting the following information:
- Hospitalization policies, including clinical protocols for determining when transfers are warranted, definitions of avoidable versus unavoidable hospitalizations, and whether staff must consult Optum supervisors before hospital transfers.
- Bonus program metrics and thresholds, including how UnitedHealth determines APK limits, whether facilities are penalized for exceeding thresholds, and five years of documentation on bonus payments to nursing homes.
- Advance directive policies, including training materials for end-of-life conversations, the mortality risk assessment tool used, and who participates in those discussions with residents.
- Marketing and enrollment practices for I-SNP plans at contracted nursing homes.
- Federal oversight and compliance, including any CMS sanctions or enforcement actions in the past five years.
“UnitedHealth Group will continue to engage with Senators Warren and Wyden and their staff,” a spokesperson for the company told Becker’s. “We categorically reject any assertion that UnitedHealth Group or Optum engage in practices that endanger patient safety or violate ethical standards. Our approach improves outcomes, reduces unnecessary hospitalizations, and supports individualized care planning—always prioritizing the health, safety, and dignity of those we serve. We stand firmly behind our program, which has provided decades of compliant, specialized care and support for seniors in nursing homes.”
