Revealed: UnitedHealth secretly paid nursing homes to reduce hospital transfers

[BumRushDaShow]

Source: The Guardian

Wed 21 May 2025 11.45 EDT
First published on Wed 21 May 2025 06.00 EDT


UnitedHealth Group, the nation’s largest healthcare conglomerate, has secretly paid nursing homes thousands in bonuses to help slash hospital transfers for ailing residents – part of a series of cost-cutting tactics that has saved the company millions, but at times risked residents’ health, a Guardian investigation has found.

Those secret bonuses have been paid out as part of a UnitedHealth program that stations the company’s own medical teams in nursing homes and pushes them to cut care expenses for residents covered by the insurance giant.

In several cases identified by the Guardian, nursing home residents who needed immediate hospital care under the program failed to receive it, after interventions from UnitedHealth staffers. At least one lived with permanent brain damage following his delayed transfer, according to a confidential nursing home incident log, recordings and photo evidence.

“No one is truly investigating when a patient suffers harm. Absolutely no one,” said one current UnitedHealth nurse practitioner who recently filed a congressional complaint about the nursing home program. “These incidents are hidden, downplayed and minimized. The sense is: ‘Well, they’re medically frail, and no one lives for ever.’”

Read more: https://www.theguardian.com/us-news/2025/may/21/unitedhealth-nursing-homes-payments-hospital-transfers

[LakeVermilion]

1. This is incredibly disrespectful to the employees of the nursing homes...

Nursing homes are not known for the wages that they pay their workers. In fact they have been known to understaff these homes. Both UnitedHealth and the cooperating nursing homes should be sanctioned for putting both employees and residents at risk.

Beyond respulsive...

[Blackjackdavey]

2. Kind of a ridiculous story

But what else can be expected of journalism these days.

Hospital diversion programs aren't secret or controversial in the general sense. Efforts to reduce inpatient hospitalizations is literally state policy in my world as there are many benefits to doing so and providing increased reimbursement rates or providing other kinds of financial incentive is obviously the only way for outpatient providers to do it since they need staff and equipment.

Therefore, was it secret, really? And if so, in what way, why? "No one" investigates harm to patients? Really? In what state, what context? What location doesn't have mandated reporting, vulnerable persons registries, investigations of harm? This is all relevant to understanding what this is about beyond finding things that happened, someone who doesn't know how things work speaking innuendo and the salacious "united healthcare."

[58Sunliner]

4. Have you ever worked in a nursing home?

Hospital diversion programs function when a pt doesn't need the level of care a hospital provides, that a nursing home can provide. If I understand correctly, what they are referring to is when a pt needs to transfer from a nursing home to a hospital for increased level of care and tests. They can send pts out for tests, but do not have the staff to provide the care necessary for round the clock monitoring, or access to immediate tests and procedures as necessary.

[Blackjackdavey]

6. A 24 hour 7 day a week

Care facility every single day. Whose primary mission in life is avoiding inpatient hospitalizations and paid by insurance companies to do it, to include Medicare and Medicaid. That's how I know there is a lot more information needed to know what this is about. For example, in your interpretation, which boils down to "not enough staff," that has nothing whatsoever to do with the insurance company but rather the state's mandated ratio and the facilities commitment to maintaining the bare minimum despite receiving incentives to monitor in house care. There is simply more info needed to interpret what is going on other than providing clickbait.

[58Sunliner]

8. No, you are deliberately misconstruing what I posted.

It is a fact that most facilities do not have enough staff for more than standard checks, and some fail at that standard. You conveniently left out the needs for testing and procedures that homes can not provide, or have the skilled staff necessary to administer. I know that staffing is an issue when trying to get a Dr. to sign off on a transfer for pt care needs. I also know the ball gets dropped and pts suffer when the chain of command for facilitating transfers is stymied by bureaucracy created to deny costs.
"Whose primary mission in life is avoiding inpatient hospitalizations and paid by insurance companies to do it, to include Medicare and Medicaid"-Sounds like you have incentives to restrict care and deny transfers. Also sounds sounds like you do not actually work in a home, unless it is managed by your insurance company, and you would not be floor staff, but administrative.

[Blackjackdavey]

10. I'm sorry

but your response seems more aggressive than necessary. I haven't deliberately misconstrued anything, I don't even think I'm disagreeing with you.

I'm saying: insurance companies reimburse facilities for provided care and in turn facilities generate revenue. Facility administrators decide what percentage of that revenue goes into staffing, equipment, etc. vs. executive salaries, etc. Therefore, the capabilities present within any given facility or program are determined by administrators and board members, not the payors. It is possible that the insurance company is, in their opinion, paying for some kind of enhanced care that the facility isn't in turn providing.

I'm also saying this: hospital diversion is not in and of itself a bad thing, in fact, it is a good thing. There is plenty of research that suggests hospitalization, especially for frail elders, makes things much worse and oftentimes is the beginning of the end. Additionally, as we know, inpatient hospitalization is very expensive and is often used for services that can be provided more cheaply elsewhere.

Therefore, this article that wants to capitalize on the hot button "UHC" doesn't seem to get to the heart of what is actually going on here while creating an irrational response: hospital diversion = withholding care. It is certainly possible that someone doesn't get the care they need in the time they need it, happens all the time, but in my experience, 9 times out of ten that has more to do with the facility administration rather than the insurance company.

[58Sunliner]

3. How sick. I hope they get sued. Some of them deserve life in prison.

[Joinfortmill]

5. And they wonder why people want to kill them.

[summer_in_TX]

7. My friend's experience with a local nursing home just this last month certainly seemed substandard to

me.

Her dad, age 74, broke his femur. After surgery at a South Austin hospital and several days treatment for ileus, he was transferred to a nursing home ten minutes from my house.

Besides the broken bone, he had several bedsores, one or more of which had necrotic tissue. He arrived on a Thursday evening, assessment was done on Friday, and it wasn't until the following Thursday before a wound care specialist treated his necrotic wounds. (Nursing staff treated him in the meantime.)

He failed to thrive, barely eating, vomiting often. His daughter was told he had dementia. He was very lucid the times I talked to him (the day after he was admitted and the same day he asked to leave, as well as another day), and was well-mannered and compliant. No sign of depression. Later in the week, she was presented with a packet on hospice and preparing for death and dying.

After a week and a half, he told a staff member he wanted to be transferred to another facility. Later that evening a new medicine was prescribed, supposedly to stimulate his appetite, which also had psychiatric effects. (Mirtazapine) After that was started, he got a visit from the director of nursing, he was asked by the director of nursing who asked him in a manner I considered potentially manipulative in the audio recording the daughter made. Asking didn't he like it there, and was he really unhappy there, and did he really want to leave. Of course, being a nice person (and maybe under the influence of the mirtazapine), he said no.

The daughter had an MPOA executed after he'd been there an almost two weeks, but the nursing home failed to honor it. The nursing home throughout his stay would not provide her with information about the medications and course of treatment, because of HIPAA and because mother was next of kin. Daughter came repeatedly, mother never visited (mental health issues), but it was quite awhile before she had the information about her dad. At one point a doctor who covered for the main doctor periodically called her at home and told the daughter he had pneumonia. The next day she asked them to take him to a hospital. They told her he didn't have pneumonia, and asked him if he wanted to go to the hospital. He said no. I texted our town's director of EMS about my concerns. He went over and checked the dad out, couldn't find pneumonia, and the dad said he'd eaten a little and did a little walking with assistance. Dad said he didn't need to go to a hospital.

Five days later they do transfer him to a hospital for pneumonia, the necrotic bedsores, and continued weight loss. The hospital treats him for almost a week–the worst of the bedsores has infected down into the bone—then a week ago they send him to a long-term acute care hospital. The wound care specialist told me there that the wound almost certainly would not be fully healed for SIX MONTHS. And until it healed he couldn't begin rehab.

He's still at the LTAC although they wanted to move him to a nursing home with a skilled nursing bed and wound care specialist. At least one nursing home refused to take him because they can't give him the level of care he needs. He's continued to vomit off and on and getting enough nutrition to heal is a big concern.

I don't see obvious signs of dementia and never have. My dad, who is gone now, had it so the early and even middle stages are not necessarily very obvious. Her dad seems lucid and intelligent, now and then with minor touches of confusion.

The nursing home here did seem to me to use HIPAA to prevent family members from having the info they needed, didn't treat his wound in a timely manner or adequately, and was very slow to get him to a hospital. The timing of the prescription of mirtazapine was suspicious and when it wasn't working they did not wean him off it.

I do not know if they were a nursing home bribed by UnitedHealth, but it would not surprise me to learn they were after what I observed and what the daughter and her dad went through. Of course, he should have been in a nursing home that had skilled nursing beds, and this one didn't. But the daughter had no way of knowing that.

[58Sunliner]

9. How awful.