UnitedHealth Group is facing serious allegations regarding its treatment of elderly patients, particularly those in nursing homes. A whistleblower complaint claims the company prioritized cost savings over patient care, suggesting that it intentionally delayed or denied necessary medical treatment.
The allegations have prompted a strong response from UnitedHealth, which has denied any wrongdoing. The company pointed to a previous investigation by the Department of Justice, which reviewed extensive documentation and interviewed multiple witnesses before deciding not to pursue the case. UnitedHealth stated that the DOJ found “significant factual inaccuracies” in the whistleblower’s claims.
In a recent statement, UnitedHealth addressed a report from The Guardian that suggested the company engaged in Medicare fraud. They argued that the report relied on anecdotal evidence and misrepresented their healthcare programs.
Two former nurse practitioners from UnitedHealthcare, represented by Whistleblower Aid, allege that the company operated under a “playbook” that led to the withholding of care from elderly patients. They claim that the company created an environment that intimidated healthcare providers and discouraged them from recommending necessary treatments. One whistleblower, Maxwell Ollivant, stated that many elderly patients went without needed care as a result of cost-cutting measures.
UnitedHealth responded by asserting that Ollivant was not in a position to accurately assess its programs and emphasized that his criticisms were based on personal anecdotes. They noted that he later withdrew his lawsuit voluntarily.
The company has also denied specific claims about its policies regarding hospital admissions and patient transfers. UnitedHealth stated that prior approval for hospital admissions is not required, countering allegations that patients were denied emergency care due to bureaucratic delays. Additionally, they refuted claims that elderly patients were misled into signing do-not-resuscitate orders, insisting that their providers support informed decisions based on ethical standards.
Another serious allegation involved a stroke patient whose symptoms were allegedly misdiagnosed by a UnitedHealth call center operator, resulting in delayed hospital admission and long-term harm. UnitedHealth rejected this claim, stating that providers are not required to seek approval before making hospitalization decisions.
The company is also dealing with separate legal challenges over its use of artificial intelligence in care decisions. A lawsuit claims that UnitedHealth used an algorithm to limit coverage for post-acute care services without adequately considering patients’ health needs.
These controversies come at a challenging time for UnitedHealth, as its stock has dropped more than 50% since April amid increased regulatory scrutiny and leadership changes. The company has faced past legal issues related to Medicare billing practices, including a 2017 complaint alleging inflated risk adjustment claims.
As these allegations unfold, the focus remains on how they will impact UnitedHealth’s reputation and operations in the healthcare industry.