Democratic Sens. Ron Wyden (Oreg.) and Elizabeth Warren (Mass.) are launching an investigation into UnitedHealth Group (UHG) over its actions reportedly steering seniors away from hospital visits for the sake of cutting costs.
In a letter to UHG CEO Stephen J. Hemsley, Wyden and Warren cited reporting from outlets including The Guardian that said his company was paying nursing homes to reduce hospital transfers of sick patients.
The senators wrote that UHG representatives told them bonus programs for nursing homes are offered to encourage “adherence to certain quality measures.”
One of these programs allows for nursing homes to receive bonuses if they reach certain levels of influenza and pneumococcal vaccination rates and cholesterol medication adherence rates, while also maintaining a hospital admission per thousand rate below a certain threshold.
They also pointed to UHG institutional special needs plans, provided through its subsidiary Optum, which reportedly disincentivize “medically-necessary hospitalizations and emergency room visits.” These plans also reportedly pressure nursing home residents to sign “do not resuscitate” (DNR) and “do not intubate” (DNI) orders.
At the time of The Guardian’s reporting in May, UHG denied it was preventing hospital transfers or pushing patients to sign DNRs and DNIs.
“Put simply, these allegations suggest that UHG appears to be prioritizing its bottom line at the expense of the health and safety of nursing home residents enrolled in UHG I-SNPs. Nursing home residents and their families should not live in fear of a for-profit health care company withholding care when it is most critical,” the lawmakers wrote.
Though they expressed their support for evidence-based models that reduce “unnecessary hospitalizations of nursing home residents,” Wyden and Warren noted a briefing with UHG representatives did not resolve their concerns surrounding these reports.
The lawmakers requested information on UHG’s I-SNP model, Optum’s policies on transferring residents on I-SNP to the hospital as well as information on its bonus programs.
“Any attempt to take advantage of vulnerable nursing home residents is unacceptable, especially to pad a for-profit insurance company’s revenues. It is vital that UHG respond to these alarming reports and provide prompt, detailed responses to our questions,” wrote Wyden and Warren.
