Investigation Alleges United Healthcare Paid Nursing Homes to Delay Proper Care

Investigation Alleges United Healthcare Paid Nursing Homes to Delay Proper Care

A recent investigation by the Guardian has revealed that the medical insurance giant United Healthcare helped ensure that nursing homes did not transfer patients to hospitals in order to save money, despite this causing harm to the residents of the nursing homes. These secret payments helped United save millions but placed the lives of many at risk. The cooperation between United and the nursing homes runs deep, and investigations show that the process was possible because the insurance company embedded its own nurse practitioners and clinicians in nearly 2,000 facilities across the US who would then monitor a key metric called “admits per thousand” (APK) and steer nursing homes toward reduced hospitalizations even if it meant the patient would be harmed.

This leaves many scared about the care their families are receiving in nursing homes and the potential for delayed care and abuse. These fears are not unfounded as nursing home abuse frequently leaves families seeking justice for their loved ones.

How the Scheme Worked

UnitedHealth rewarded nursing homes financially for keeping hospital admission rates low—sometimes paying hundreds of thousands extra annually. Facilities with higher APK received nothing, tightening the tie between patient care decisions and profit margins. Despite the many whistleblowers and witness statements, United says that it was only paying bonuses to nursing homes for helping them prevent “unnecessary hospitalizations that are costly and dangerous to patients and that its partnerships with nursing homes improve health outcomes”. Tactics allegedly included:

1. Delaying transfers to hospitals
2. Persuading patients to change DNR status
3. Training nursing home staff to follow United Healthcare protocol and to coordinate medical decisions with them
4. Delaying calls to doctors and calling United Healthcare representatives first

Profit over Safety

In several reported cases, urgent hospital transfers were delayed or blocked—resulting in severe patient harm, including permanent brain damage. A UnitedHealth nurse practitioner has filed congressional complaints alleging that incidents are downplayed or ignored. “No one is truly investigating when a patient suffers harm,” the whistleblower said. The callous attitude towards these residents led to dehumanization.

‘Well, they’re medically frail, and no one lives forever.’”

Cost Cutting Tactics

A recent investigation has revealed that UnitedHealth, the country’s largest healthcare provider, implemented covert strategies to reduce costly hospitalizations for nursing home residents—often at the expense of patient care.

Among these alleged tactics were “budgets” issued to staff, essentially placing limits on how many hospital admissions were permissible. Facilities with fewer “Do Not Resuscitate” (DNR) orders were flagged, and UnitedHealth employees were encouraged to convince vulnerable residents to change their end-of-life directives, prioritizing cost control over patient wishes.

Even more troubling, whistleblower lawsuits allege that some nursing homes leaked confidential resident data to UnitedHealth sales teams, enabling aggressive enrollment tactics. One former employee reportedly falsified documents to bypass federal protections, pushing cognitively impaired seniors into Medicare Advantage plans without valid consent.

These revelations highlight the risks of prioritizing profit over care in elder communities, with growing calls for regulatory oversight and accountability.

Downplaying Serious Conditions and Delaying Hospital Visits

UnitedHealth allegedly inserted its own clinicians into nursing home emergency protocols—sometimes delaying hospital transfers even when residents exhibited clear signs of dangerous conditions like strokes.

One alarming case occurred in 2019 at a facility in Washington. Around midnight, a resident presented with classic stroke symptoms—slurred speech and unilateral arm paralysis. Instead of authorizing immediate hospital transfer, a remote UnitedHealth provider ruled it a possible transient ischemic attack (TIA), a less serious diagnosis, and recommended lab tests with a four-hour follow-up

Every minute is critical in stroke treatment: delays can result in permanent brain damage. Independent medical records show this expert never informed the patient’s personal physician and instructed facility staff to wait—contrary to standard stroke care protocol.

The Guardian revealed another troubling case where a UnitedHealth protocol delayed the hospitalization of a resident showing classic signs of a stroke. After the on‑site nurse notified the remote UnitedHealth team, no prompt transfer was authorized. Frustrated by the delay, the nurse bypassed UnitedHealth and later contacted the resident’s independent physician—who immediately ordered emergency care.

By the time transfer occurred—about an hour later—the resident exhibited permanent neurological deficits such as slurred speech and facial drooping on one side, as shown in photos and audio recordings obtained by investigators.

What does this mean for your loved one?

Families entrust nursing homes with their loved ones’ care. When profit incentives overshadow medical need:

• Urgent hospital transfers can be delayed
• Code status decisions (e.g., DNR orders) may be improperly influenced
• Patient privacy and autonomy are at risk

If you suspect that care was intentionally delayed or denied, consider consulting a nursing home wrongful death lawyer. These attorneys are experienced in:

• Investigating internal contracts and care logs
• Interviewing whistleblowers and gathering declarations
• Collecting medical records and expert testimony
• Pursuing claims under the False Claims Act or state-level wrongful death statutes

Legal intervention not only seeks justice but can also illuminate systemic issues—pushing both nursing homes and insurers to put patient welfare above cost.

KBD Attorneys: Advocating for the Vulnerable

At KBD Attorneys, we fiercely represent victims of nursing home abuse, group home neglect, and systemic failures across the United States. Our mission is clear: pursue justice, demand accountability, and drive meaningful reform.

Reach out today for a free and confidential consultation.

References

Gedeon, J. & Joseph, G. (2025). UnitedHealth faces federal scrutiny into whistleblower claims. The Guardian. https://www.theguardian.com/us-news/2025/jun/10/unitedhealth-investigation-whistleblower-nursing-homes

https://ocasio-cortez.house.gov/sites/evo-subsites/ocasio-cortez.house.gov/files/evo-media-document/2025.06.09-letter-re-uhc-allegations-to-doj-and-hhs-oig.pdf

https://www.unitedhealthgroup.com/newsroom/2025/2025-05-21-statement-regarding-may-21-article-the-guardian.html