Senate Finance Committee Ranking Member Ron Wyden, D-Ore., and Senator Elizabeth Warren, D-Mass., sent a letter to the company on Thursday asking for details about their practices following a May report by the Guardian that the insurer has delayed hospitalizations and used aggressive tactics to lower nursing home costs.
The Guardian article reported that UnitedHealth quietly paid nursing homes bonuses to reduce hospital transfers, a cost-cutting tactic that saved the company millions. UnitedHealth said at the time of the publication that the Department of Justice previously reviewed the allegations and declined to pursue the matter. In June, UnitedHealth sued the Guardian for defamation.
RELATED: Guardian report exposes UnitedHealth’s secret payments to nursing homes
In their letter to UnitedHealth Group CEO Stephen J. Hemsley, Wyden and Warren wrote that they are concerned that the bonus program provides a heavy incentive to nursing homes to limit hospitalizations of all kinds to meet a metric that can be poorly suited to measure patient health and safety.
RELATED: UnitedHealth sues Guardian over report about secret payments to nursing homes
The reports of the cost-cutting programs imperil the health, safety, and lives of vulnerable seniors and people with disabilities who live in nursing homes, they wrote. “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,” Wyden and Warren said.
They note that the incentive practices aim to cut health care spending for residents enrolled in UnitedHealth Group institutional special needs plans (ISPs), which are Medicare Advantage plans designed to serve members who are dually eligible for Medicare and Medicaid who live in skilled nursing facilities. The company’s I-SNP model is administered by care providers through its subsidiary, Optum.
Although the company provided a briefing to Senators on July 29, Wyden and Warren said they have outstanding questions about how the company’s programs are structured and their effects on patient safety. While the company denied the allegations in the Guardian’s reporting and maintains that it follows best practices in the care of nursing home residents, the senators said that the methods the company uses may incentivize practices that threaten resident safety.
In a press release, Wyden’s office said the investigation follows reports that residents in nursing homes contracted by United Health Group have experienced delays in hospitalization that may be attributed to incentive schemes that offer bonuses to nursing homes to maintain hospitalization rates below a certain threshold. In some cases, these delays allegedly resulted in permanent harm to residents, such as delayed treatment of a stroke. They also noted that Optum has reportedly been pushing residents to sign Do Not Resuscitate or Do Not Intubate orders as part of the company’s broader cost savings program.
“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 letter said. “We are concerned that these metrics appear to be more attuned to higher profits than to better patient care.
Wyden and Warren have asked UnitedHealth Group to provide by September 8 documents and information about its reported nursing home incentive programs related to hospitalization policies, advance directives, and marketing practices. They also want information about the role of federal and state oversight in the company’s nursing home line of business.