Is UnitedHealth Incentivizing Nursing Home Neglect?

UnitedHealth Group’s Nursing Home Cost Reduction Tactics

UnitedHealth Group has been in the news quite a bit over the last several years. With botched AI claim denials, the death of their CEO, and now, with an investigation that has led to accusations of wrongful death and delayed care for nursing home patients.

While insurance companies are meant to help people get the care they need, it’s easy to forget that they are companies, meaning they have shareholders, and their main goal is to make money and increase their profit margins. Over the years, UnitedHealth Group has found “creative” ways to increase their profit margins, and in some cases, this seriously affects elderly policy holders who are in nursing homes.

Last year, reports surfaced of UnitedHealth Group using dangerous and aggressive tactics to lower the cost of nursing home care. Among these tactics, it is reported that UnitedHealth Group’s subsidiary Optum, “aggressively pushes residents to sign Do Not Resuscitate (DNR) or Do Not Intubate (DNI) orders as a part of the company’s broader cost savings program.”

And these cost-saving tactics don’t end there. An investigation is underway showing that UnitedHealth allegedly offered bonuses or incentives to nursing homes with lower hospital transport rates, even when residents and patients required emergency services.

In The Article

Is UnitedHealth Offering Bonus Programs to Limit Hospital Transports of Nursing Home Residents?

According to The Guardian, UnitedHealth used its “Quality and Shared Risk” program to offer “an even bigger cut to nursing homes that drove down medical spending, but threatened to claw back money from those that didn’t.” The Guardian article goes on to explain that they measured the rate of nursing home residents being sent to the hospital as “admits per thousand,” or APK. A former UnitedHealth Group executive said that this APK was the driver for everything in the nursing home sector, stating, “You gain profitability by denying care.”

If this former executive’s statement proves true through investigation, UnitedHealth is truly offering incentives to nursing homes at the risk of their patients.

Is UnitedHealth Group Incentivizing Nursing Home Neglect?

While the insurance giant denies incentivizing deaths and neglect of nursing home patients, whistleblowers and investigations are pointing toward something else. One nurse practitioner for UnitedHealth stated, “No one is truly investigating when a patient suffers harm… These incidents are hidden, downplayed and minimized.” However, UnitedHealth holds the position that bonuses for reduced hospital transports is to encourage nursing home employees to take initiative in patient care.

In a letter to the insurance giant, Senator and Senate Finance Committee Ranking Member, Ron Wyden of Oregon wrote, “these bonus programs provide a heavy incentive to nursing homes to limit hospitalizations of all kinds, even where necessary.”

Being denied proper care and lifesaving hospitalizations puts residents in danger of severe injury, and even death. This type of neglect could lead to nursing home liability claims, even if the health insurance giant wasn’t incentivizing it, but can an insurance company be held liable for nursing home wrongful death cases?

Can UnitedHealth Group Be Held Liable for Wrongful Death in Nursing Homes?

Yes. There could potentially be a strong case that UnitedHealth is liable for wrongful death in nursing homes, should an investigation produce clear evidence that UnitedHealth Group breached their duty of care. As an example, if a resident of a nursing home is denied a medical transport, and it is proven that UnitedHealth and the nursing home knew their policies would affect the patient, both UnitedHealth Group and the nursing home could be liable for the death of the resident.
There is legal precedent for suing health insurance companies for wrongful death and injury. As a matter of fact, UnitedHealth has been sued for wrongful denial of claims and reductions in reimbursements before. For example, in 2021, UnitedHealth agreed to pay $14.3 million for customers denied mental healthcare substance abuse treatment by the insurance giant.

For this specific investigation, nursing home abuse attorneys may look at two items to build their cases against UnitedHealth.

Care denial

Care denial happens when an insurance company refuse to cover medical treatments, services, and/or medications to their policyholders. When it comes to the nursing home neglect issue, United’s nursing home methods could potentially lead to a lawsuit, due to the fact that some who were denied hospital transports were further injured due to the denial of care.

Bonuses for Negligence

Should an investigation find that UnitedHealth Group was incentivizing negligence by giving bonuses to nursing homes with lower hospital transport rates, and penalizing nursing homes with too many hospital transports, they may also face gross negligence claims. If a case like this goes to trial, a jury may award punitive damages, due to the knowledge and wanton practices that could have potentially led to wrongful death.

What to Do if Your Loved One Was Denied Proper Care in a Nursing Home

If your loved one was denied proper care in a nursing home, the first thing you should do is file a complaint with the nursing home. If you’re worried that your loved one is in danger, you should file a police report and report health facility complaints to the New Mexico Department of Health at 1-800-752-8649. You should also file a complaint with the New Mexico Human Services Department.

Finally, you should call a nursing home neglect lawyer in New Mexico. At Ron Bell Injury Lawyers, we know how important your loved ones are to you, and if you suspect your loved one is being neglected or denied proper care in a nursing home, we are ready to investigate and fight for you. Call us today to get your free case evaluation. 898-BELL

Other Lawsuits Against United Health Group

UnitedHealth Group is a massive conglomerate with thousands of subsidiaries in the healthcare industry. These subsidiaries have been subject to dozens of lawsuits over the years. Some of these include:

• Antitrust violations
• Pension and Benefit Plan Violations
• Competition-Related Offenses
• Consumer Protection related offenses
• Controlled Substances Act Violation (Optum RX)
• Overcharging for health insurance