UnitedHealth has refused to hand over key internal records to lawmakers investigating the company’s efforts to reduce hospital transfers for nursing home residents, according to a letter sent to the company by the US senators Ron Wyden and Elizabeth Warren.
The veteran lawmakers, both members of the powerful Senate finance committee, launched their inquiry last summer following a Guardian investigation into bonuses that UnitedHealth pays to nursing homes that reduce hospital transfers for their residents. Those are hospitalizations the insurance giant would otherwise have to pay for.
UnitedHealth did not directly respond to questions from the Guardian about the senators’ assertion that the company had failed to turn over internal documents. But it said in a statement it would “continue to engage” with the senators and that its nursing home care program “improves outcomes” and “reduces unnecessary hospitalizations”.
The new letter from the senators says that in the five months since they formally requested a tranche of documents about the initiative, UnitedHealth has “declined to produce” any internal records on its hospitalization policies or bonus payments and only provided “brief and unsubstantial answers” in response to their questions.
“Because you have failed to respond adequately to our inquiry – and in light of additional recent reporting – we are renewing our inquiry with heightened alarm,” Wyden and Warren wrote in the letter, dated 7 January.
That “additional recent reporting” referred to a December story by the Guardian reporting on allegations of three wrongful deaths involving the company’s nursing home care program, which allows staff from UnitedHealth’s medical arm, Optum, to care for residents insured by its insurance arm, UnitedHealthcare.
In a statement to the Guardian, UnitedHealth said it categorically rejects any assertion that it engages in practices that “endanger patient safety or violate ethical standards”.
“We stand firmly behind our program, which has provided decades of compliant, specialized care and support for seniors in nursing homes,” a UnitedHealth spokesperson said.
The letter provides new details on Wyden and Warren’s investigation into UnitedHealth.
On 29 July the senators’ offices held a briefing with UnitedHealth in which the company maintained that nursing homes in its program are not required to have conversations with the company’s direct care division before sending residents to the hospital, according to the letter.
Wyden and Warren wrote that this claim “is at odds” with a company document, which was provided to the Senate finance committee by a whistleblower. The document showed that UnitedHealth pushed nursing homes to “immediately” call its direct care division even if they were sending out an insured UnitedHealth member “urgently”, according to the senators’ letter.
After the briefing, most of the Senate staff’s questions “were unresolved”, the letter says. UnitedHealth was “unable to justify”, for example, its use of hospital admission rates as a metric for determining bonus payments to nursing homes, Wyden and Warren wrote. Such metrics do not distinguish between necessary and unnecessary hospitalizations, as the senators have previously noted.
In the new letter, the senators recirculated their previous document demands and gave UnitedHealth until 28 January to respond.
“If you fail to respond in full, we will pursue answers to this critical inquiry by other policy means,” they continued.
Under Medicare Advantage, insurers such as UnitedHealth receive fixed payments from the federal government that cover the medical expenses of long-term nursing home residents. The fewer hospitalizations they have to pay for, the more in federal funds they have left over for potential profits.
UnitedHealth and its medical care division, Optum, are facing lawsuits relating to its nursing home program, as the Guardian previously reported.
In Ohio, the family of a retiree named Mary Grant is suing UnitedHealth, claiming that the 70-year-old died after her nursing home and UnitedHealth’s Optum division failed to send her to the hospital, though she had suffered a traumatic head injury and began vomiting.
The Optum nurse practitioner overseeing the senior’s care was acting not “as an independent and objective medical professional” but instead as “an insurance adjuster” so the healthcare giant could “pre-emptively deny Mary Grant necessary medical care”, the family alleged in their court complaint.
In Georgia, the family of a woman named Cindy Deal is alleging that staff from her nursing home and Optum failed to hospitalize the 58-year-old for hours, though she had started foaming at the mouth and appeared to be having a seizure, resulting in her death.
The company “acted to block the provision of life-saving care to Ms Deal pursuant to corporate policies intended to increase profits at the expense of its insured”, an amended complaint from last November alleges.
UnitedHealth did not directly respond to questions about these cases.
UnitedHealth has previously declined to directly respond to questions about the cases, citing patient privacy rules and the pending nature of the litigation, but said generally that many of the claims were unsubstantiated or based on incomplete or embellished information.
The company has previously denied claims from Grant and Deal’s families in court.
“United works with the nursing facility, primary care physicians, and specialists to deliver appropriate care for members in the most appropriate setting,” the company previously told the Guardian, noting that a non-profit called the National Committee for Quality Assurance recently awarded its care model a 98.75% score.
In June, UnitedHealth sued the Guardian, alleging defamation for a story about bonuses the company paid to nursing homes that helped it to reduce hospital transfers for their residents. The suit was the latest in a series of aggressive tactics aimed at silencing critics, the New York Times reported.
In the wake of the suit, the Guardian stood by its story, and continued to report on the company’s nursing home practices.
