{"id":354615,"date":"2025-12-17T20:29:07","date_gmt":"2025-12-17T20:29:07","guid":{"rendered":"https:\/\/www.newsbeep.com\/au\/354615\/"},"modified":"2025-12-17T20:29:07","modified_gmt":"2025-12-17T20:29:07","slug":"unitedhealth-reduced-hospitalizations-for-nursing-home-seniors-now-it-faces-wrongful-death-claims-us-healthcare","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/au\/354615\/","title":{"rendered":"UnitedHealth reduced hospitalizations for nursing home seniors. Now it faces wrongful death claims | US healthcare"},"content":{"rendered":"

Three nursing home residents died because employees of the American healthcare giant UnitedHealth Group<\/a> helped delay or deny them critical hospital care, two pending lawsuits and a complaint to state authorities have alleged.<\/p>\n

The three cases involve a UnitedHealth partnership initiative that places medical staff from the company\u2019s direct care unit, Optum, inside nursing homes to care for residents insured by the company\u2019s insurance arm.<\/p>\n

UnitedHealth says one of the initiative\u2019s goals is to protect patients by reducing unnecessary<\/a> hospital admissions. Those are admissions the insurance giant would otherwise have to pay for.<\/p>\n

In Georgia, the family of a woman named Cindy Deal filed a lawsuit alleging<\/a> that the 58-year-old died because Optum and her nursing home failed to hospitalize her for hours after she started foaming at the mouth and appeared to be having a seizure.<\/p>\n

In Ohio, the family of a retiree named Mary Grant filed a lawsuit claiming<\/a> that the 70-year-old died after Optum and Grant\u2019s nursing home failed to send her to the hospital, though she had suffered a traumatic head injury and began vomiting.<\/p>\n

Mary Grant\u2019s daughter browses photographs of her mother on her phone. Photograph: Maddie McGarvey<\/p>\n

In New York, a physician\u2019s assistant named Christopher Bieniek alleged in a complaint to state authorities that a 63-year-old nursing home resident died due to \u201cgross negligence\u201d by an Optum employee. The employee refused to hospitalize the man, despite his kidney failure, according to text messages Bieniek says he shared with state investigators.<\/p>\n

Citing patient privacy rules and pending litigation, UnitedHealth\u2019s public relations team did not directly respond to specific questions about the three cases, but said that many of the claims were unsubstantiated or based on incomplete or embellished information.<\/p>\n

The company has previously<\/a> denied<\/a> the Grant and Deal families\u2019 claims in court, and attorneys representing UnitedHealth disputed some of Bieniek\u2019s claims.<\/p>\n

\u201cWe remain confident in our transparency, our compliance and our steadfast commitment to patient-centered care,\u201d the company said. \u201cWe will not legitimize a one-sided and misinformed narrative by further engaging with it. Our focus continues to be where it belongs: delivering high-quality care for our members and standing with the clinicians and care teams who devote themselves every day to improving patients\u2019 lives.\u201d<\/p>\n

The three cases highlight the dual role that UnitedHealth has taken on for thousands of nursing home residents across the country: medical insurer and provider of direct care.<\/p>\n

Like many American health insurers, UnitedHealth has expanded across the healthcare sector and no longer limits itself to simply paying or denying its members\u2019 medical bills.<\/p>\n

In nursing homes, for example, the conglomerate deploys its own army<\/a> of nurse practitioners and physician assistants from its medical services arm, Optum, to care for seniors covered by its insurance arm, UnitedHealthcare. During the day, these medical professionals listen to heart sounds, decide on new diagnoses, and address dangerous complications for insured residents at their nursing homes. At night and on weekends, other Optum employees on hotlines weigh in on their care from afar.<\/p>\n

Optum headquarters in Eden Prairie, Minnesota, USA. Photograph: JHVEPhoto\/Alamy<\/p>\n

UnitedHealth insures more than 55,000 long-term nursing home residents through what are known as institutional special needs plans (I-SNPs), which are funded through the federal government\u2019s Medicare Advantage program. While other insurers also employ their own medical providers, UnitedHealth is by far the biggest player in the I-SNP market<\/a>, covering almost as many residents as all of its rivals combined.<\/p>\n

UnitedHealth says this hands-on nursing home model provides an \u201cextra layer of caring support<\/a>\u201d that helps reduce unnecessary hospital trips for long-term residents at more than 1,900 nursing homes in 29 states across the US. \u201cUnited works with the nursing facility, primary care physicians, and specialists to deliver appropriate care for members in the most appropriate setting,\u201d the company said in an email, noting that a nonprofit called the National Committee for Quality Assurance recently awarded its care model a 98.75% score.<\/p>\n

Hospitalizations, the company notes, can lead to serious issues for nursing home residents, such as delirium, falls and pressure injuries.<\/p>\n

They can also lead to major expenses for the insurance giant, a financial arrangement that lawmakers<\/a> and corporate whistleblowers have framed as a potential conflict of interest incentivizing the conglomerate to discourage necessary hospitalizations too.<\/p>\n

Under Medicare Advantage, the government pays insurers like UnitedHealthcare a set amount of money based on the expected healthcare needs of each senior enrolled in their insurance plans for long-term nursing home residents. The less insurers spend on residents\u2019 care, the more they have left over in taxpayer funds for potential profit.<\/p>\n

In addition to the complaints from the families and the outside medical provider, UnitedHealth\u2019s nursing home initiative has been the subject of at least four whistleblower complaints from former employees. The whistleblowers allege that employees from Optum, UnitedHealth\u2019s direct care subsidiary, engaged in unethical tactics that sought to curb costly but critical hospital care, or violated federal rules meant to protect nursing home residents from predatory insurance sales tactics.<\/p>\n

Two of the whistleblowers, both former Optum nurse practitioners, filed declarations with Congress, alleging that company managers improperly pressured them to reduce hospital transfers for nursing home seniors, and to get residents onto medical directives, such as \u201cDo-Not-Resuscitate\u201d orders, that could pre-empt costly emergency room care. The declarations also allege that supervisors pushed them to creatively code patient diagnoses to increase federal payments for the company.<\/p>\n

UnitedHealth said it categorically rejected any suggestion that its employees engage in practices that endanger patient safety or violate ethical standards. It said that the suggestion that its employees prevented hospital transfers was false, and that its permission is not required for nursing home residents to go to the hospital.<\/p>\n

The company added that \u201cthe insinuation that the desire to decrease unnecessary hospitalizations is motivated solely by financial considerations ignores well established evidence of the harm unnecessary hospitalizations can cause.\u201d<\/p>\n

Policy experts say reducing unnecessary hospitalizations is important to cutting wasteful expenditures and protecting frail nursing home residents, but caution that these efforts must allow medical providers to follow their genuine clinical judgments.<\/p>\n

\u201cYou don\u2019t want to then overcorrect and basically align the incentives so that people are never sent to the hospital when they really need to go to the hospital for appropriate care,\u201d said Gretchen Jacobson, vice-president of Medicare policy at the Commonwealth Fund, a healthcare research nonprofit.<\/p>\n

Medical researchers have found that a sizable portion of hospitalizations of nursing home residents may be unnecessary. A study<\/a> published in July in the medical journal JAMDA, for example, found that one-third of hospital admissions among thousands of \u201cseverely impaired\u201d nursing home residents appeared to be \u201cpotentially avoidable hospitalizations\u201d.<\/p>\n

But while there has been research on the benefits of avoiding unnecessary hospitalizations for nursing home residents, there has been less study on how such efforts may have \u201covercorrected\u201d and \u201cresulted in less access to care generally\u201d, according to Jacobson.<\/p>\n

\u201cWe need to take a fresh look to make sure that programs like this are balancing the incentives correctly, and we don\u2019t know if that balance is right,\u201d she said.<\/p>\n

In June, UnitedHealth sued the Guardian alleging defamation for a previous story about UnitedHealth\u2019s efforts to reduce hospitalizations among nursing home residents.<\/p>\n

The lawsuit from the healthcare giant, which brought in more than $400bn in revenue last year, was the latest in a series of aggressive tactics aimed at quieting its critics, the New York Times reported<\/a>.<\/p>\n

In the wake of the suit, the Guardian stood by its story, and continued its reporting process, which identified the three allegations of wrongful deaths.<\/p>\n

These allegations, as well as details from four whistleblower complaints about United Health\u2019s I-SNP nursing home program, have never previously been made public by the press or government agencies.<\/p>\n

\u201cWe are disappointed the Guardian has continued a pattern of biased and misleading reporting that does not reflect the value of the I-SNP clinical model or the benefits we provide to our members,\u201d UnitedHealth said in a statement. \u201cThe inaccuracies have been so persistent and harmful we have pursued legal action \u2013 an extraordinary step we take to protect the integrity of our work, our care teams and the people we serve.\u201d<\/p>\n

After the Guardian published its first story<\/a> on UnitedHealth\u2019s nursing home initiative, Senators Ron Wyden and Elizabeth Warren held a briefing with UnitedHealth<\/a> about its nursing home program and decided to launch<\/a> an investigation seeking company documents.<\/p>\n

\u201cNursing home residents and their families should not live in fear of a for-profit health care company withholding care when it is most critical,\u201d the senators wrote in a letter to the company.<\/p>\n

A whistleblower\u2019s complaint<\/p>\n

When Maxwell Ollivant first started working as a nurse practitioner for UnitedHealth\u2019s nursing home program, he believed in his company\u2019s care model.<\/p>\n

Maxwell Ollivant. Photograph: George Joseph\/The Guardian<\/p>\n

As an employee of UnitedHealth\u2019s direct care subsidiary, Optum, Ollivant\u2019s job was to visit and check on dozens of seniors at three nursing homes in the suburbs of Tacoma, Washington. The goal: to identify medical complications early and address them, protecting residents from needless hospitalizations.<\/p>\n

Ollivant was excited to work in geriatric care. When he was young, his grandfather had supported him after the shock of his parents\u2019 divorce. Now he would be able to care for seniors like him.<\/p>\n

Less than a year into the new job, however, the nurse practitioner, a committed Christian, started to have concerns that his company was going too far, inserting itself into nursing home emergencies and effectively delaying or discouraging necessary hospitalizations, according to the lawsuit and congressional declaration he later filed.<\/p>\n

When Ollivant visited his assigned nursing homes, he saw images with large red STOP signs in his patients\u2019 charts, according to the declaration Ollivant filed in May with Congress as well as the Securities and Exchange Commission, the Federal Trade Commission and the Washington state attorney general. The signs instructed nursing home staff to call UnitedHealth\u2019s Optum unit first, rather than their independent primary care doctors, when a patient\u2019s condition worsened, the declaration said.<\/p>\n

If a nursing home did send a patient to the hospital without first contacting Optum and following various protocols, Ollivant and his colleagues \u201cwere instructed to chastise the nursing facility staff\u201d, the declaration said.<\/p>\n

Such scrutiny could even follow a hospitalization for an emergency situation, as one Optum email stemming from Ollivant\u2019s litigation indicates.<\/p>\n

In that case, nursing home staff sent a resident to the hospital because she was found drooling, unresponsive and with a \u201cslant to the side\u201d, the email said. The<\/a> symptoms<\/a> pointed to a possible stroke, an emergency that requires rapid treatment, and the woman was subsequently admitted to a hospital\u2019s intensive care unit for \u201cintrabrain bleeding\u201d, a life-threatening<\/a> type of stroke, according to the email.<\/p>\n

But after the transfer, Ollivant\u2019s manager emailed her team that the nursing home had sidestepped the company\u2019s protocol, failing to take the time to first call a hotline operated by Optum\u2019s off-site medical staffers.<\/p>\n

\u201cThis is by pass,\u201d the manager wrote, referring to Optum\u2019s term for when nursing home staff skipped over its intermediary clinicians to hospitalize a resident. \u201cNursing did not call Optum on call.\u201d<\/p>\n

The manager then met with the nursing home\u2019s director of nursing services and scheduled an in-service training to re-educate the facility\u2019s nurses, the email shows. <\/p>\n

UnitedHealth did not directly respond to questions about this email. <\/p>\n

Four months later, Ollivant went to UnitedHealth\u2019s HR team with concerns about his company\u2019s response to another emergency, involving a patient of his, public records from the Washington state attorney general show.<\/p>\n

One Sunday earlier in September, the 66-year-old nursing home resident had been found with potential stroke symptoms, but his transfer to a hospital was delayed after his nursing home contacted UnitedHealth\u2019s on-call hotline, instead of an independent doctor, according to Ollivant\u2019s lawsuit, which referred to the man by his initials, \u201cM.T.\u201d<\/p>\n

For Ollivant, the incident showed the danger of Optum\u2019s involvement in emergency cases, according to the congressional declaration he later filed.<\/p>\n

In its defamation suit and in statements to the Guardian, UnitedHealth maintained that it repeatedly pushed for M.T.\u2019s transfer and faulted its nursing home partner for failing to hospitalize the retiree earlier.<\/p>\n

Days after Ollivant reported his concerns about M.T. to UnitedHealth\u2019s HR department, the company began investigating the nurse practitioner himself, records released by the company to the Guardian show. It concluded that Ollivant had failed to properly care for M.T. during a second incident which the nurse practitioner had also complained about, according to the company records.<\/p>\n

Ollivant submitted his resignation that February \u2013 just over three weeks after he filed his internal complaint.<\/p>\n

The nurse practitioner later sued UnitedHealth, then voluntarily dismissed his suit after the US Department of Justice declined to intervene in the case. In early May, with the assistance of the legal advocacy organization Whistleblower Aid, Ollivant submitted his declaration to state and federal authorities expanding on his previous claims.<\/p>\n

In a statement, UnitedHealth said that Ollivant was \u201cnot in a position to assess the effectiveness of our programs\u201d, claiming he \u201clacks both the necessary data and the expertise\u201d.<\/p>\n

\u201cOur position is supported by peer-reviewed studies and measurable outcomes,\u201d the company said. \u201cIn contrast, the criticisms being raised are based on anecdotes.\u201d<\/p>\n

Between July 2024 and June 2025, long-term nursing home members covered by UnitedHealth experienced 38,000 transfers to the ER and 16,000 hospital admissions, the company said. Of those admissions, it said, nearly half were ordered by skilled nursing facilities or primary care physicians without Optum\u2019s involvement.<\/p>\n

UnitedHealth also said that the Department of Justice investigated the whistleblower claims, interviewing witnesses and obtaining thousands of documents that \u201cdemonstrated significant factual inaccuracies in the allegations\u201d. UnitedHealth previously told the Guardian that the Department of Justice found the allegations to be \u201cmeritless\u201d and \u201cfound no evidence of wrongdoing\u201d.<\/p>\n

UnitedHealth did not respond to requests from the Guardian that it provide evidence for this claim.<\/p>\n

\u2018The goal is to treat in place\u2019<\/p>\n

Mary Grant, the nursing home resident in Ohio, never made it to the hospital.<\/p>\n

Photographs of Mary Grant in a family album. Photograph: Maddie McGarvey\/The Guardian<\/p>\n

One evening two years ago, when a nurse at her facility in Cleveland found the 70-year-old low on oxygen and covered in pinkish chunks of vomit, she called the care hotline operated by UnitedHealth\u2019s Optum subsidiary, instead of an independent doctor, according to nursing notes and an Optum audio recording released through litigation.<\/p>\n

The day before, a nursing home employee had accidentally rammed a cart into Grant, knocking her out of her wheelchair, according to a lawsuit that her family filed in state court in Ohio and was later moved to federal court. Her head, protected only by strands of thin, gray hair, hit the concrete floor, leaving a bump on her forehead, patient records released through discovery and the lawsuit assert.<\/p>\n

Now Grant was experiencing nausea and vomiting \u2013 signs<\/a> of potential bleeding inside her head, according to a doctor who later filed an affidavit as part of the lawsuit. To assess whether Grant was bleeding internally and needed surgery, she needed to go to a hospital and get a CT or MRI scan, the suit claimed.<\/p>\n

But the Optum hotline employee that the nursing home nurse called for instruction \u201cdid not order\u201d Grant\u2019s transfer to the hospital, according to the suit. After hearing about the fall and head bump from Grant\u2019s daughter and Grant\u2019s vomiting and low oxygen levels from the nurse, the Optum liaison determined that a transfer was not yet necessary, according to a UnitedHealth call log disclosed in response to the suit.<\/p>\n

\u201cThe goal is to treat in place,\u201d a log from the Optum employee noted later that evening, using language reflecting<\/a> the company\u2019s efforts to curb unnecessary hospital transfers. \u201cBut if condition worsens, send to Soft Point [sic] hospital.\u201d<\/p>\n

Yalonda Phillips looks at a photo from her wedding day with her mother, Mary Grant. Photograph: Maddie McGarvey<\/p>\n

The Optum employee told the nursing home to continually check Grant\u2019s vital signs, order a chest X-ray at her facility, and give her medicine and oxygen, company logs and audio recordings released through discovery in the suit show.<\/p>\n

This plan of care that Optum coordinated with its nursing home partner failed to reckon with the possibility that Grant had suffered a traumatic head injury that was causing a growing pool of blood to compress the tissue in her brain, according to court filings by her family.<\/p>\n

The next day, nursing home staff found the retiree dead in her room, according to nursing home notes released through litigation.<\/p>\n

In August, attorneys Michael Hill and Matthew Mooney filed a lawsuit on behalf of Grant\u2019s family alleging that the off-site nurse practitioner for UnitedHealth\u2019s Optum unit was not acting \u201cas an independent and objective medical professional\u201d on the company\u2019s hotline, but instead as \u201can insurance adjuster\u201d so that the healthcare giant could \u201cpreemptively deny Mary Grant necessary medical care\u201d.<\/p>\n

In a court filing, UnitedHealth denied the Grant family\u2019s allegations.<\/p>\n

UnitedHealth\u2019s public relations team did not directly respond to questions about the Grant case, but said in a statement: \u201cWhere litigation is ongoing, we are limited in what we can share, but we contest inaccuracies and will vigorously defend ourselves.\u201d<\/p>\n

Allegations of upcoding and changing medical orders to increase federal dollars<\/p>\n

The other former Optum employee who filed a whistleblower declaration with Congress submitted it while still working at the company. Like Ollivant, the clinician \u2013 who has chosen to remain anonymous \u2013 said they were initially supportive of UnitedHealth\u2019s nursing home initiative.<\/p>\n

Once on the job, however, the nurse practitioner discovered that their team was under pressure to reduce hospitalizations while inserting questionable diagnosis codes into patients\u2019 charts in order to increase federal payouts to UnitedHealth, according to the declaration provided to state and federal agencies.<\/p>\n

\u201cIt felt so unprofessional and bizarre, based on other medical facilities I worked in, to have managers challenge well-established critical interventions in cut-and-dry cases,\u201d the whistleblower wrote.<\/p>\n

Bonuses went to nurse practitioners who rarely transferred residents to the hospital and who mined colleagues\u2019 charts for lucrative diagnosis codes they could use to bill the federal government, the nurse practitioner wrote.<\/p>\n

Staff went through training to learn how to deploy diagnosis codes for weak foot pulses and minor skin spotting, and would be re-educated by company coding specialists if their coding was deemed insufficient, the declaration alleges.<\/p>\n

\u201cThese changes in codes did not change the treatment plan, but they did generate higher Medicare Advantage payments for UnitedHealthcare,\u201d according to the declaration.<\/p>\n

UnitedHealth did not directly respond to a question on the allegations about its employees coding patient diagnoses to increase federal dollars. But the company said in an email that the Centers for Medicare and Medicaid Services gave UnitedHealth\u2019s nursing home plan a 4.5 star rating.<\/p>\n

The declarations from the anonymous whistleblower and Ollivant also alleged that UnitedHealth\u2019s Optum unit pushed to get nursing home residents to consider medical directives, such as \u201cDo-Not- Resuscitate\u201d and \u201cDo-Not-Hospitalize\u201d orders, which can limit access to life-saving interventions and pre-empt costly hospitalizations. <\/p>\n

UnitedHealth pointed out that advanced care planning has a positive impact on the quality of residents\u2019 end of life care and said that the company tracks residents\u2019 care preferences \u201cto align the care provided with the patient\u2019s health and care goals\u201d. <\/p>\n

In the declaration, the anonymous whistleblower acknowledged that advanced care planning is \u201cvery necessary\u201d. But Optum staff, the nurse practitioner wrote, sometimes convinced patients to agree to orders limiting their care through counseling that failed to make clear that some of their ailments may be reversible, and that patients with chronic conditions might still benefit from hospitalization for less serious complications.<\/p>\n

\u201cThis resulted in what seemed to be a de-escalation of care,\u201d the whistleblower wrote, for patients \u201cwho desired to live longer without extraordinary measures but still sought treatment for manageable conditions\u201d, such as heart failure, urinary tract infection, or acute kidney injury.<\/p>\n

In his declaration, Ollivant echoed these concerns, describing the conglomerate\u2019s \u201cpush\u201d for \u201cDo-Not-Resuscitate\u201d and \u201cDo-Not-Hospitalize\u201d orders as an \u201cunconscionable measure\u201d that sought to reduce UnitedHealth\u2019s costs while increasing its profits.<\/p>\n

UnitedHealth denies these claims.<\/p>\n

The company said Optum clinicians are trained to have high quality conversations about advance care planning to allow members and families to make the most informed decisions possible. The company said that it has never encouraged or pushed a member to sign a \u201cDo-Not-Hospitalize\u201d or \u201cDo-Not-Resuscitate\u201d order.<\/p>\n

\u201cOur health care providers are ethically bound to respect patient autonomy and support informed decision-making,\u201d UnitedHealth said in an email.<\/p>\n

UnitedHealth\u2019s June lawsuit criticized the Guardian\u2019s previous reporting on allegations about its advanced care planning practices. Company whistleblowers, however, were not alone in questioning its discussions with patients and their families about such care directives.<\/p>\n

More concerns about UnitedHealth\u2019s end-of-life planning push<\/p>\n

In August of 2023, Christopher Bieniek, a physician assistant working for an independent medical group in upstate New York, filed a complaint with state authorities alleging that \u201cgross negligence and incompetence\u201d by an Optum nurse practitioner working at a nursing home alongside him \u201cresulted in the death\u201d of a resident experiencing congestive heart failure and kidney failure.<\/p>\n

According to the complaint, the 63-year-old resident was complaining of dizziness and had very low blood pressure. But when Bieniek pushed for the resident to go to the hospital citing his kidney failure, the Optum employee simply responded \u201cno\u201d, according to text messages Bienek says he showed to investigators from New York\u2019s office of professions, the state\u2019s licensing authority.<\/p>\n

Screenshot of a text message that Christopher Bieniek said he showed to state authorities. Photograph: Christopher Bieniek<\/p>\n

\u201cNo? He has symptomatic hypotension with end organ dysfunction,\u201d Bieniek replied on the text chain, noting that the man needed rapid IV fluid injections which he could not receive at the nursing home. The 63-year-old\u2019s medical orders form \u201csays to send to hospital when medically necessary\u201d, Bieniek pointed out.<\/p>\n

Instead of helping to get the man to the hospital where he might have received costly but life-saving care, Bieniek alleged in his complaint, the Optum employee \u201ctalked the family into changing\u201d his care goal to comfort care \u2013 an end-of-life approach \u2013 \u201cdespite the condition being readily treatable and probably reversible even at that late stage\u201d.<\/p>\n

The nursing home resident died soon thereafter, according to Bieniek\u2019s complaint, which specifically pointed to UnitedHealth\u2019s financial stake in his patient\u2019s care.<\/p>\n

\u201cThere is also significant conflict of interest at play as the patient in his decompensated state would have likely required hospitalization and higher cost of medical care which in working for the insurance company would conflict with their goals,\u201d Bieniek wrote.<\/p>\n

The Optum employee, Bieniek continued, had on more than one occasion \u201ctalked a family into changing goals of care to palliation when the patient has an easily treatable and reversible condition such as an acute infection\u201d.<\/p>\n

Bieniek said he was interviewed by state investigators, but never heard what happened to the case afterwards.<\/p>\n

Rachel Connors, a spokesperson for the New York State Education Department, which oversees the office of professions, declined to comment on the case, citing confidentiality requirements.<\/p>\n

The Optum employee did not respond to requests for comment.<\/p>\n

In response to questions about Bieniek\u2019s complaint, Jered Ede<\/a> and Thomas Clare, attorneys representing UnitedHealth, said that the Optum employee had been nominated for an excellent service award by the nursing home that year. The attorneys also said the resident\u2019s family had asked for palliative care and that the Optum employee \u201cdid nothing except ensure the patient was cared for in the way the family wanted\u201d.<\/p>\n

Dr Ferdinando Mirarchi, an expert on advance care directives<\/a>, told the Guardian that he was invited by a nursing home in Erie county, Pennsylvania, to review the medical orders of residents living there, including some covered by UnitedHealth.<\/p>\n

Between 2017 and 2018, Mirarchi interviewed over one hundred patients there, covered by multiple insurers, and found that some of their paperwork did not align with the care goals they described to him.<\/p>\n

When residents covered by UnitedHealth plans told him that they wanted fewer future medical interventions, the doctor helped them to amend their care orders and got no pushback, he recalled. But Mirarchi said that when he did the opposite \u2013 changing residents\u2019 medical orders because residents \u201cwanted to go to the hospital\u201d or \u201cwanted to be resuscitated\u201d \u2013 UnitedHealth\u2019s Optum team \u201cgot annoyed\u201d and sometimes complained to nursing home administrators or families that he was meddling.<\/p>\n

Dr Ferdinando Mirarchi. Photograph: Daniel Lozada\/Photo by Daniel Lozada for The Guardian<\/p>\n

A few months into his review, Mirarchi said, tensions boiled over at a meeting in which he told Optum staffers that he didn\u2019t want the company\u2019s lower-level providers altering his orders after he had identified errors in patients\u2019 files.<\/p>\n

\u201cI\u2019m a physician. I got a hell of a lot more training and experience than those they have assigned to come in there and have conversations with patients,\u201d Mirarchi, who has authored more than a dozen medical journal articles on advance care planning, told the Guardian. \u201cAnd they\u2019re trying to tell me I\u2019m doing wrong.\u201d<\/p>\n

UnitedHealth said its training on discussing potential medical orders with patients comes from \u201cgold-standard materials developed by the Harvard School of Public Health and Ariadne Labs, ensuring patients and families are supported through these decisions\u201d.<\/p>\n

In a letter, attorneys representing UnitedHealth noted that more than half of the patients whose medical orders Mirarchi helped to correct voluntarily chose to de-escalate their care. The attorneys also pointed out to a past statement<\/a> from Mirarchi that discussions about people\u2019s end-of-life wishes should not be a \u201cone-and-done\u201d practice.<\/p>\n

Allegations about UnitedHealth sales practices<\/p>\n

When Brook Gonite first started pitching UnitedHealth\u2019s Medicare Advantage plans in nursing homes across Georgia, the salesman believed his team was in compliance with guidelines intended to protect vulnerable seniors, according to a federal whistleblower lawsuit he later filed.<\/p>\n

Gonite, an employee of UnitedHealth\u2019s Optum unit, would sit in the common rooms of nursing homes with his colleagues, wait to be approached by residents or their families, and offer them contact authorization forms to sign, the lawsuit claims.<\/p>\n

But this approach, Gonite alleges in the suit, became impossible to maintain once a new manager took over his team and ratcheted up its monthly sales goals.<\/p>\n

Brook Gonite. Photograph: A former colleague of Gonite\u2019s<\/p>\n

At one early meeting, the lawsuit claims, the manager told subordinates that he didn\u2019t care how they made their Medicare Advantage enrollment numbers \u201cas long as you make me look good\u201d.<\/p>\n

Gonite\u2019s lawsuit alleges that his sales team violated multiple federal rules \u2013 cajoling nursing home staff to leak them seniors\u2019 confidential medical records, cold-calling seniors without required contact authorization cards, and offering nursing home operators payments if they helped market the healthcare giant\u2019s plans.<\/p>\n

Nursing homes that contracted with UnitedHealth could earn monthly fees for every new member that joined UnitedHealth\u2019s long-term nursing home plan, giving them part of the company\u2019s Medicare Advantage revenues, according to Gonite\u2019s suit. Nursing homes that helped the insurer reduce hospitalizations could get quarterly \u201cpremium dividend\u201d bonuses, or other incentive payments that offered them a percentage of UnitedHealth\u2019s savings on medical expenses, according to Gonite\u2019s lawsuit, internal company documents and documents released through public records requests.<\/p>\n

At one meeting with a nursing home near Georgia\u2019s border with South Carolina, Gonite\u2019s manager told the facility\u2019s staff they needed to get 40% of the home\u2019s residents onto UnitedHealth\u2019s Medicare Advantage plan if they wanted to move forward with the contract, the suit alleges. (The manager declined an interview request and did not respond to detailed requests for comment for this story.)<\/p>\n

Following the manager\u2019s instructions, the nursing home\u2019s director of clinical evaluations handed over lists with the names of all his residents \u2013 as well as their ages, Medicare ID numbers and other personal information \u2013 so that Gonite\u2019s team could solicit seniors and their families, according to the lawsuit. At least 16 residents at the nursing home joined UnitedHealth\u2019s Medicare Advantage plan, Gonite\u2019s complaint alleges.<\/p>\n

In court filings, UnitedHealth has characterized Gonite as a \u201cdisgruntled, terminated employee\u201d and denied that any of the company\u2019s payments to nursing homes amounted to illegal kickbacks.<\/p>\n

In a statement, UnitedHealth denied that it imposed enrollment thresholds on nursing homes or offered financial incentives to nursing homes to enroll residents. Its payments, the company said, incentivize improvements in patient care quality and reimburse \u201cmember services\u201d.<\/p>\n

UnitedHealth claimed that Gonite was fired for his own unethical conduct, claiming the company caught him falsifying enrollment materials and fraudulently enrolling residents at several nursing homes into its Medicare Advantage plans. All of this, a company spokesperson said, \u201cwas done without the company\u2019s knowledge and in violation of company policy\u201d.<\/p>\n

The UnitedHealth spokesperson said the company\u2019s firing of Gonite was an example of its \u201cdecisive corrective action\u201d when learning of \u201cimproper sales tactics\u201d, and noted that the Department of Justice had declined to pursue Gonite\u2019s allegations against the company.<\/p>\n

UnitedHealth\u2019s defamation lawsuit accuses the Guardian of irresponsibly relying on Gonite and other \u201cfacially unreliable sources\u201d.<\/p>\n

Tom Clarkson, Gonite\u2019s attorney, declined to comment on UnitedHealth\u2019s allegations against his client, but noted that the federal judge overseeing the lawsuit had allowed the case to proceed.<\/p>\n

In April, federal judge Marc Treadwell ruled that Gonite\u2019s complaint \u201cplausibly alleges\u201d that UnitedHealth violated HIPPA, the federal law that protects the confidentiality of patients\u2019 medical information, as well as federal rules aimed at protecting vulnerable nursing home residents from aggressive sales tactics.<\/p>\n

Alleged pressure to cut corners<\/p>\n

In court documents, UnitedHealth\u2019s attorneys reject Gonite\u2019s allegations and refer to his boss as a \u201cpurportedly rogue sales director\u201d.<\/p>\n

But last year, Abbi Mathis, the other former Optum sales employee turned whistleblower, made similar allegations in a lawsuit filed in Iowa state court, claiming that her boss at Optum also used nursing home residents\u2019 confidential medical records to solicit signups, and barged into one resident\u2019s room without permission to try to sell them a Medicare Advantage plan. <\/p>\n

In another instance, Mathis alleges in her complaint, her boss tried to approach a nursing home resident, who was unable to speak and simply bobbed his head and smiled in response to his entreaties.<\/p>\n

Mathis believed the man had a traumatic brain injury and wasn\u2019t capable of consenting to an enrollment with UnitedHealth, the suit claims. The suit alleges that when she objected to these tactics, her supervisor told her: \u201cIt\u2019s not our job to decide whether someone is able to be self-responsible or not.\u201d<\/p>\n

Mathis left the job after filing a human resources complaint about her boss, according to her lawsuit against Optum. She settled the lawsuit this year, according to court documents and her attorney.<\/p>\n

Asked for comment about the allegations, Mathis\u2019s former boss said in a brief phone call that he did not \u201cwant to be involved\u201d. He did not provide answers to specific questions the Guardian subsequently sent him about his former subordinate\u2019s claims.<\/p>\n

A UnitedHealth spokesperson said it trains its sales agents on ethical practices and that when it learns of improper sales tactics, it takes decisive corrective action, including terminating employees for violating company policy.<\/p>\n

Attorneys representing UnitedHealth told the Guardian that Mathis\u2019s claims \u201cwere never substantiated or corroborated\u201d, but that the company terminated the supervisor \u201cas soon as it corroborated other allegations that the supervisor may have violated marketing guidelines and company policy\u201d.<\/p>\n

Two wrongful death lawsuits<\/p>\n

In 2022, the family of Cindy Deal, the Georgia nursing home resident, filed a suit alleging that UnitedHealth\u2019s care subsidiary Optum and its nursing home partner failed to promptly hospitalize her after she suffered an apparent seizure and started foaming at the mouth one evening. <\/p>\n

Though Deal was unresponsive, her nursing home nurse consulted with an Optum nurse practitioner, who directed her to give Deal medicine, instead of ordering her to transfer Deal to the hospital, according to an affidavit filed by a medical expert who reviewed health records from the incident on behalf of her family.<\/p>\n

Deal continued to gasp and struggled to breathe and it took until 1.30am \u2013 nearly three hours after she was found foaming at the mouth \u2013 for the nursing home to receive an order to call 911, the affidavit alleges. According to an amended complaint filed by Deal\u2019s family in November, the authorization for that ambulance call came from another Optum nurse practitioner starting her shift.<\/p>\n

Five minutes later, EMS responders found Deal laying in bed unconscious with pale skin, large open pupils and discolored lips, the affidavit states. Deal was pronounced dead shortly after she arrived at the hospital at 2.07am, according to the affidavit.<\/p>\n

Deal\u2019s symptoms indicated she was \u201cexperiencing a potentially life ending medical emergency\u201d, the expert, Dr Bruce Charash, wrote. \u201cBased on a reasonable degree of medical certainty or probability,\u201d he wrote, Deal died from cardiopulmonary arrest because the nurse and nurse practitioners involved in her care \u201cfailed to appreciate the significance associated with Cindy Deal\u2019s declining health and promptly request medical transport to a hospital\u201d.<\/p>\n

Darren Penn, an attorney for Deal\u2019s family, said he reviewed notes from an Optum nurse practitioner involved in the case, which were released through discovery in the lawsuit. In an interview with the Guardian citing the notes, Penn alleged that the Optum employee specifically told the nursing home hours before Deal\u2019s death that it did not need to transfer her to the hospital.<\/p>\n

Deal\u2019s nursing home initially denied the family\u2019s claims in court, then settled the case last year for an undisclosed amount.<\/p>\n

Optum remains a defendant in the case. In court records, attorneys for Optum have denied the family\u2019s allegations and asserted that its nurse practitioner \u201cmet or exceeded the applicable standards of care\u201d. The attorneys did not respond to a request from the Guardian for comment.<\/p>\n

The other wrongful death lawsuit against UnitedHealth was filed by Yalonda Phillips, the daughter of the Ohio nursing home resident, Mary Grant.<\/p>\n

Yalonda Phillips outside of her home in Cleveland, Ohio, in September. Photograph: Maddie McGarvey<\/p>\n

On the night of 18 August 2023, Phillips received a call from an off-site Optum employee about her mother vomiting, an escalation in symptoms after her fall from her wheelchair, which resulted in a bump on her head the day before.<\/p>\n

Though the caller identified herself as an employee of Optum, UnitedHealth\u2019s care subsidiary, Phillips said in an interview that she thought she was speaking to someone from the nursing home. She didn\u2019t realize, she said, that she was speaking to a representative of a company tied to her mother\u2019s insurer.<\/p>\n

During the call, Phillips told the Optum employee that her mother had a bump on her forehead, which she described as \u201csensitive to the touch\u201d, a company recording of their conversation released in discovery shows.<\/p>\n

The Optum employee, a nurse practitioner who had not examined the 70-year-old in person, assured Phillips that it didn\u2019t \u201cseem as if\u201d her mother was in \u201cany acute distress\u201d, citing a prior conversation with a nursing home supervisor, the recording continues. If Grant\u2019s condition got worse they would send her to the hospital, the off-site clinician promised, according to the recording.<\/p>\n

At about 10pm that evening, the Optum employee called a doctor and reported: \u201cShe has a knot on her forehead, but it doesn\u2019t sound like a hematoma or anything.\u201d The doctor then OK\u2019d continuing to treat Grant at the facility after speaking to the Optum employee for less than two minutes, according to a recording of their conversation.<\/p>\n

Because Grant was kept at the nursing home, the suit claims, the 70-year-old never received an MRI, which would have allowed surgeons to figure out whether she had internal head bleeding and proceed to surgery<\/a> if warranted.<\/p>\n

The Optum employee did not respond to questions for this story.<\/p>\n

No autopsy was performed after Grant\u2019s death, and in her death certificate the nursing home\u2019s medical director later attributed her passing to various years-old conditions that did not refer to the head injury, according to the family\u2019s lawsuit.<\/p>\n

In an affidavit, Dr Timothy Klein, a medical expert hired by Grant\u2019s family, said the knot on her forehead was likely a hematoma pointing to internal head trauma. Grant\u2019s vomiting and nausea the next day were likely the symptoms of that traumatic head injury, caused by blood spurting out inside her head and pooling up outside her brain, according to the affidavit.<\/p>\n

Lying in her bed alone in the final hours before her death, Grant likely experienced an \u201cintense headache as pressure built up within her skull, compressing her brain\u201d, the affidavit says. As the pressure inside her head eroded her body\u2019s ability to function, Klein wrote, Grant\u2019s lungs were also likely being filled with stomach fluids \u2013 a process that would have caused her \u201cintense pain\u201d as she was in essence \u201cdrowning in her own vomit\u201d.<\/p>\n

At 12.06pm on 19 August 2023, the day after Grant had begun vomiting, a nursing home nurse once again called the Optum hotline.<\/p>\n

It looked like the senior had vomited again and now she was not breathing, the nurse reported on the recorded line. She could not get a pulse.<\/p>\n

A remote Optum employee offered to call Grant\u2019s daughter. The nurse agreed, saying, \u201cI\u2019m like a wreck right now.\u201d<\/p>\n

By the time Phillips rushed to the nursing home, it was too late, the recordings show. The daughter was not able to comfort her mother as she passed away.<\/p>\n

\u201cWorking dx [diagnosis]: Cessation of life,\u201d the Optum log from 12.09pm noted.<\/p>\n

Eight minutes later Grant was officially pronounced dead, according to company records.<\/p>\n

In court documents, Optum denied the Grant family\u2019s allegations.<\/p>\n","protected":false},"excerpt":{"rendered":"Three nursing home residents died because employees of the American healthcare giant UnitedHealth Group helped delay or deny…\n","protected":false},"author":2,"featured_media":354616,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[34],"tags":[64,63,137,500],"class_list":{"0":"post-354615","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-healthcare","8":"tag-au","9":"tag-australia","10":"tag-health","11":"tag-healthcare"},"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/posts\/354615","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/comments?post=354615"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/posts\/354615\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/media\/354616"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/media?parent=354615"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/categories?post=354615"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/tags?post=354615"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}