In the weeks since the below article revealed allegations against UnitedHealth, members of Congress are calling for action. At least one US Senator and two Representatives are engaged in the allegations. Senator Wyden (D-OR) announced that his office is launching its own investigation. Senator Hawley (R-MO), who is on the investigations subcommittee said it was “alarming to hear these serious allegations. I look forward to securing justice for patients, policyholders, and whistleblowers alike who’ve been harmed by insurance companies.” Other Senators expressed similar sentiments.
“If these allegations are true, UnitedHealth must be held responsible for their gross abuse of patients. Patients should always come before profits.”
Buddy Carter
Chair of the House subcommittee on health,U.S. Representative, (R-GA)
Three U.S. Representatives, coming from both sides of the aisle, are calling on the DoJ to investigate. A letter to the DoJ reads:
“The Guardian’s findings reveal the need for a wide-ranging investigation by the Department of Justice into years, if not decades, of potential waste, fraud, and abuse at UnitedHealth.”
Here is another take on the breaking news story, published by whistlebloweraid.org
The Guardian has uncovered some truly disturbing information about UnitedHealth Group. As the investigation and reporting belongs to them, I have reprinted the first part of the article here. Read the full article here.
by George Joseph, The Guardian Wed May 21, 2025
Revealed: UnitedHealth secretly paid nursing homes to reduce hospital transfers
A Guardian investigation finds insurer quietly paid facilities that helped it gain Medicare enrollees and reduce hospitalizations. Whistleblowers allege harm to residents
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.’”
Confidential Investigation
The Guardian’s investigation is based on thousands of confidential corporate and patient records obtained through sources, public records requests and court files, interviews with more than 20 current and former UnitedHealth and nursing home employees, and two whistleblower declarations submitted to Congress this month through the non-profit legal groupWhistleblower Aid.
The documents and sources provide a never-before-seen window into the company’s successful effort to insert itself into the day-to-day operations of nearly 2,000 nursing homes in small towns and urban commercial strips across the nation – an approach which has helped UnitedHealth secure a vast stream of federal dollars from Medicare Advantage plans that cover more than 55,000 long-term nursing home residents.
UnitedHealth Responds
UnitedHealth said the suggestion that its employees have prevented hospital transfers “is verifiably false”. It said its bonus payments to nursing homes help prevent unnecessary hospitalizations that are costly and dangerous to patients and that its partnerships with nursing homes improve health outcomes.
Long-Term Profit
Under Medicare Advantage, insurers collect lump sums from the federal government to cover seniors’ care. But the less insurers spend on care, the more they have for potential profit – an opportunity that UnitedHealth higher-ups have systematically sought to exploit when it comes to long-term nursing home residents.
To reduce residents’ hospital visits, UnitedHealth has offered nursing homes an array of financial sweeteners that sounded more like they came from stockbrokers than medical professionals.
Seven Years of Bribery and Threats
Over the past seven years, the company hasshelled out “Premium Dividend” and “Shared Savings” payments that boosted nursing homes’ bottom lines. Through its “Quality and Shared Risk” program, UnitedHealth offered an even bigger cut to nursing homes that drove down medical spending, but threatened to claw back money from those that didn’t, according to former employees and internal corporate documents.
“You gain profitability by denying care, and when profitability suffers for the shareholders, that’s when people get crazy and do things that are not appropriate.”
Viventium Releases its 2024 Caregiver Onboarding Experience Report, Demonstrating a Need to Raise the Bar for Onboarding in the Post-Acute Care Industry
BERKELEY HEIGHTS, N.J., April 02, 2024 (GLOBE NEWSWIRE) — Viventium, the leading SaaS-based human capital management platform serving the post-acute care industry, released its 2024 Caregiver Onboarding Experience Report, a comprehensive research study analyzing survey responses from 175 post-acute care administrators and 220 caregivers. The report finds a shockingly low bar for what passes as a “good” onboarding experience in home-based and facility/community-based care, with strong indications that raising that bar could correlate to higher retention rates.
“Staffing shortages and high turnover rates within post-acute care are recurring issues in need of solutions,” said Navin Gupta, Viventium CEO. “Our research illuminates a crucial pathway towards addressing these persistent challenges, and it begins with onboarding.”
Findings point to post-acute care managers and administrators having a major impact on the steps their organization can take to better engage, motivate, and retain its caregiving staff.
“The study significantly advances our knowledge of what it takes to recruit and retain caregivers in today’s highly competitive workforce market. The onboarding process is fully within the control of the employer, and the study shows that doing it right pays dividends. Most notably, many of the elements of successful onboarding are simple improvements in the process that bring a real return on investment. I would encourage all of home care to learn from this study.”
About Viventium
Viventium provides a SaaS-based human capital management solution that is focused on the post-acute care industry. The company’s mission is to enrich the lives of caregivers through technology so they love going to work every day. By providing specialized software and expert guidance, Viventium helps its clients throughout the lifecycle of each caregiver. The company has clients in all 50 states and supports over 420,000 client employees each year.
with Bob Roth, Managing Partner at Cypress HomeCare Solutions
Saving for Long-term Care Starts in High School
What is the primary focus for an 18-year-old? Graduating high school, getting into the college or career training program of their choice, their first apartment, perhaps their first car, and their first adult job are things that come to mind. As the parent of a 20-year-old and a 16-year-old, I can attest to most of these and have encouraged both my kids to plan for them. Of course, the 18-year-olds might tell you they are focusing on spending time with friends, travelling, having fun, “finding” themselves, discovering their passion, and learning how to adult. These are all important as well. I’m sure there are other items you would add to these lists. But, how many of you would put long-term care on that list? How many of you were planning for private pay personal care services when you were 18? I’d guess not many of you.
One Expert's Opinion
Bob Roth, Managing Partner at Cypress HomeCare Solutions knows all too well that so many families are ill-prepared for long-term care needs for themselves and their families. In his recent article, “The aging dilemma: Long-term care”, which originally appeared in Jewish News, Roth says we should start planning for long-term care when we graduate high school. Not knowing how to provide and, especially, afford this kind of care is something Bob has seen countless times in his more than 20 years in the industry.
Long-Term Care
Long-term care can be a critical part of the health care spectrum as we age and long-term care insurance alone in the United States is inadequate. According to Roth, this stark reality prompts a crucial conversation on the state of continuing care here and around the globe. The costs of long-term care are up, the need for quality care threatens economic fallout, and the current models are unsustainable.
According to a recent study from the Joint Center for Housing Studies of Harvard University, most older adults are unable to afford in-home or assisted living care. The number of older adults continues to rise, as does the number of cost-burdened older adults. Cost-burdened older adults pay 30 percent or more of their total household income for housing. When you add in the costs for food, transportation, medicine, etc., there is nothing left for in-home care.1
Unanswered Questions
Neither Bob nor I have answers or solutions to this problem. For many years, we’ve talked about the continuity of care across hospitals, doctors, home health, and home care. (Read our article this week on the patient data exchange network.) Perhaps a trusted exchange framework that includes personal care might one day lead to insurance coverage. In the meantime, we are looking for alternative solutions to the widening gap between people who need in-home care and people who can afford it.
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Kristin Rowan has been working at Healthcare at Home: The Rowan Report since 2008. She has a master’s degree in business administration and marketing and runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in event planning, sales, and marketing strategy. She has recently taken on the role of Editor of The Rowan Report and will add her voice to current Home Care topics as well as marketing tips for home care agencies. Connect with Kristin directly kristin@girardmarketinggroup.com or www.girardmarketinggroup.com
Bob Roth is Managing Partner of Cypress HomeCare Solutions. Bob assisted in creating Cypress HomeCare Solutions with his family in 1994. With nearly 36 years of consumer products, health care and technology experience, Bob has successfully brought the depth and breadth of his experience to the home care trade and in doing so, Cypress HomeCare Solutions has been honored to receive a number of awards over the years.
He is a well-respected and knowledgeable member of our community.
