US lawmakers on both sides of the aisle are raising concerns and seeking investigations in the wake of Guardian reporting on whistleblower claims about practices within UnitedHealth Group’s nursing home partnership programs.
One US senator has announced he is launching an investigation and two US representatives are now calling on the US Department of Justice toexpandits reported investigations of the nation’s largest healthcare conglomerate. Others said they are troubled by whistleblower allegationsreported by the Guardian– including claims that UnitedHealth paid bonuses to nursing homes to help reduce residents’ hospital transfers and used improper sales tactics to get nursing home residents to sign up for the company’s Medicare Advantage plans.
Two Democratic members of Congress – representatives Alexandria Ocasio-Cortez of New York and Lloyd Doggett of Texas –filed a letteron Monday that urges the Department of Justice to “thoroughly review new revelations from investigative reporting and whistleblower complaints, which suggest that UnitedHealth may have engaged in illegal activities”.
“The Guardian’s findings reveal the need for a wide-ranging investigation by the Department of Justice into years, if not decades, of potential waste, fraud, and abuse at UnitedHealth,” the letter read.
The lawmakers are demanding a briefing on current and planned investigations by 14 July.
UnitedHealthvigorously deniesthe whistleblowers’ allegations and says the Guardian’s reporting on these issues is “blatantly false and misleading”. In response to a question about the two representatives’ letter, the company said the Department of Justice “has already declined to pursue the matter” – a reference to the agency’s previous decisions not to intervene in two whistleblower lawsuits against UnitedHealth filed under the US False Claims Act. One of those lawsuits was ultimately dropped and the other is pending in federal court in Georgia.
Another Democrat, the Oregon senator Ron Wyden,announcedlast month on X that his office was “launching a full investigation to verify these whistleblower accounts”.
“This reporting demands further inquiry – nobody deserves to have their medical care jeopardized to pad insurance company profits,” Wyden, the ranking member of the Senate’s finance committee, said. “My staff on the Finance Committee have a decade-long record of thorough and objective investigations that follow the facts towards solutions that improve federal health care policy for all Americans.”
Senator Josh Hawley, a Missouri Republican who sits on the Senate investigations subcommittee, said it is “alarming to hear these serious allegations” about the company’s practices. “I look forward to securing justice for patients, policyholders and whistleblowers alike who’ve been harmed by insurance companies.”
Another Republican, Georgia representative Buddy Carter, expressed similar concerns. “If these allegations are true, UnitedHealth must be held responsible for their gross abuse of patients,” Carter, chair of the House subcommittee on health, said in a statement. “Patients should always come before profits.”
Senator Richard Blumenthal of Connecticut, ranking member of the Senate investigations subcommittee, said the “courage and conviction” of the whistleblowers will serve as“an impetus for reform. Shining a light on abuses of consumer trust is a call to action – and a demand for accountability.”
UnitedHealth says its partnerships with nursing homes ensure better care for seniors “through on-site clinical care, personalized treatment plans, and enhanced coordination among caregivers”. The company says these arrangements have been highly successful in helping nursing homes prevent unnecessary hospital stays that can lead to serious issues such as delirium, falls, pressure injuries and “sometimes even fatal consequences”.
Two whistleblowers who worked for UnitedHealth as nurse practitioners submitted sworn declarations in May alleging that the company had used improper tactics to reduce hospital transfers for ailing nursing home residents. Their declarations were submitted to the Securities and Exchange Commission (SEC), the Federal Trade Commission (FTC), the Washington state attorney general’s office and Congress, according to Whistleblower Aid, the non-profit assisting both nurse practitioners.
WhistleblowerMaxwell Ollivant’s declaration, first reported on by the Guardian in May, says he witnessed UnitedHealth “delay and deny medically necessary emergency care” to vulnerable nursing home residents in order to “retain more money” from the payments that the company was receiving from the US government’s Medicare Advantage program.
Under Medicare Advantage, a private alternative to traditional Medicare, the federal government pays insurers a fixed sum to cover seniors’ medical services. The less insurers spend on covering medical expenses, the more in public dollars they have left over.
Ollivant’s declaration alleges that UnitedHealth “actively avoided medically necessary hospitalizations – hospitalizations in serious life-threatening situations, or situations to avoid imminent death or incredibly catastrophic results – to keep their costs down, and drove vulnerable patients toward signing Do Not Resuscitate (DNRs) and Do Not Hospitalize orders to avoid providing hospital services for life threatening illnesses”.
UnitedHealth noted that the Department of Justice declined to join the lawsuit that Ollivant filed against the company and later dropped. The company said Ollivant “is not in a position to assess the effectiveness of our programs – he lacks both the necessary data and the expertise”.
The second whistleblower, whose declaration was filed anonymously, worked with UnitedHealth for several years. Her declaration says her experiences as a nurse practitioner within its nursing home programs gave her “first-hand insight into the evolution and impact of substandard care practices resulting from the training, culture, processes and bonus system of delays and denials of medically necessary care”. That declaration criticizes the company’s “[a]ggressive [p]ush for DNRs” and says “the decision to receive life-saving care should rest with the patient or their legal representative, not myself, and certainly not the insurance company”.
UnitedHealth said the allegations in the anonymous whistleblower’s declaration show she “did not fully understand our clinical model” and that her perspective “does not reflect the dedication and excellence of the many outstanding clinicians who understand the impact they have in supporting their patients and improving health outcomes”.
The company also denies the claims regarding DNRs.
“At no time have we encouraged or pushed” nursing home residents “to sign a DNR directive”, a UnitedHealth representative said. “Our health care providers are ethically bound to respect patient autonomy and support informed decision-making without coercion.”
The Guardian’s previous reporting also references allegations relating to the legal claims of a third whistleblower, Brook Gonite, a former salesperson for UnitedHealth’s nursing home program.
Gonite alleges in a lawsuit in federal court in Georgia that UnitedHealth wrongly solicited and enrolled vulnerable, elderly patients for its nursing home programs through improper marketing tactics, including violations of Hipaa, the federal medical privacy act, and paid kickbacks to nursing homes to obtain illegal referrals of their residents.
UnitedHealth denied those allegations and moved to dismiss Gonite’s lawsuit. The Department of Justice, which declined to formally intervene in the case, opposed UnitedHealth’s motion to dismiss.
In April, federal judge Marc Treadwell denied UnitedHealth’s motion to dismiss, finding that Gonite’s lawsuit puts forth “substantial and concerning” factual allegations that “plausibly” assert violations of federal protections meant to ensure vulnerable nursing home residents can make informed decisions about their medical care. The company continues to deny those claims and says Gonite was fired for engaging in illegal sales tactics similar to those alleged in his suit.
In a statement, the company said its employees “are trained on compliant interactions with nursing home staff and nursing home residents, in accordance with the Medicare Marketing Guidelines and other applicable laws”.
Last week, shortly before the Guardian was to publish a second story providing additional detail about Gonite’s pending lawsuit and the other two whistleblowers’ declarations, UnitedHealth filed a lawsuit against the Guardian in Delaware state court, claiming the allegations were false and libelous. In a statement, the company said “the article published by The Guardian is not only riddled with inaccuracies – it is so blatantly false and misleading that we have filed a defamation lawsuit to hold the publication accountable and bring the full truth to light”.
The Guardian has said it stands by its “deeply sourced, independent reporting, which is based on thousands of corporate and patient records, publicly filed lawsuits, declarations submitted to federal and state agencies, and interviews with more than 20 current and former UnitedHealth employees – as well as statements and information provided by UnitedHealth itself over several weeks”.