U.S. Senators Elizabeth Warren, D-Mass., and Ron Wyden, D-Ore., are pressing UnitedHealth Group for details of a program that allegedly incentivized nursing homes to avert medically necessary hospital transfers for their residents.
The Aug. 6 letter to UnitedHealth Group CEO Stephen Hemsley follows an investigation published by The Guardian in May that accused the company of incentivizing nursing homes nationwide to avoid medically necessary hospital transfers for its member residents, with some cases resulting in permanent harm to patients. UnitedHealth has denied the allegations, saying that the claims are false and have caused significant reputational damage.
The senators said that after a briefing with UnitedHealth Group officials, they remain concerned about the programs the company is deploying to reduce all-cause hospitalizations and to set advance directives at its contracted nursing homes.
“While we recognize the importance of reducing avoidable hospitalizations for nursing home residents and of determining end-of-life plans, these programs, as presented in UHG’s briefing, appear to be premised on metrics that do not adequately measure or ensure resident health and safety,” the senators said. “We are concerned that these metrics appear to be more attuned to higher profits than to better patient care.”
The senators also requested detailed information on the following topics from UnitedHealth by Sept. 8:
- Policies on hospitalization and advance directives
- Bonus metrics and thresholds for nursing homes
- Training materials and oversight processes
- Marketing and promotional practices for institutional special needs plans enrollment
- Regulatory compliance and CMS enforcement actions
A UnitedHealth Group spokesperson told Becker’s that the company has received the letter and “will continue to educate their staff and share information on the I-SNP model and its proven benefit for seniors.”
“We stand firmly behind the integrity of our I-SNP program, which consistently receives high satisfaction ratings,” the spokesperson said. “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 U.S. Department of Justice extensively reviewed these allegations and found no evidence of wrongdoing.”
In June, UnitedHealth sued The Guardian for defamation, calling its report “unquestionably defamatory.”
Separately, UnitedHealth Group said in July it is complying with the Justice Department’s criminal and civil investigations into UHG’s Medicare Advantage business.
