Two prominent Democrats are pressing UnitedHealth Group over reports that the company is engaging in cost-cutting policies that put nursing home patients at risk.
Sens. Ron Wyden, of Oregon, and Elizabeth Warren, of Massachusetts, sent a letter (PDF) to UnitedHealth CEO Stephen Hemsley, demanding additional details on the model used in its institutional special needs plans, and any policies in place at Optum regarding hospital transfers.
The pair are also seeking additional details on the "admits per thousand" metric that it reportedly uses to determine bonuses under shared savings programs for nursing homes.
"Nursing home residents enrolled in I-SNP plans can be extremely medically frail and vulnerable, making it all the more critical that providers are clearly incentivized to place the needs of nursing home residents above profits," they wrote in the letter.
UnitedHealth denies the allegations, which stem from a whistleblower lawsuit from Maxwell Ollivant, a former nurse practitioner with the company. Ollivant claimed the healthcare giant paid kickbacks to nursing homes to drive fewer patient hospital transfers.
The Department of Justice investigated and declined to intervene in the whistleblower case, and the lawsuit was eventually dropped in 2023.
Ollivant's claims were detailed in a lengthy article in The Guardian, a report that is at the crux of Wyden and Warren's concerns. UnitedHealth filed a defamation suit against the media outlet over the story, arguing that it knowingly published false allegations.
The paper, meanwhile, is sticking by its reporting.
In the letter, Wyden and Warren acknowledge that UnitedHealth denies the claims about its nursing home programs, but say that doesn't resolve their concerns.
"UHG denies the allegations in the Guardian’s reporting and maintains that its practices reflect best practices in the care of nursing home residents," they wrote. "However, we are concerned that the methods UHG appears to rely on to deliver the high-quality care it purports to provide may in fact incentivize practices that threaten resident safety."
The senators are requesting answers by Sept. 8, according to the letter.
The scrutiny on nursing home polices come as the healthcare giant navigates a slew of financial challenges and a federal criminal investigation into billing practices within its Medicare Advantage plans.