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This audio is auto-generated. Please let us know if you have feedback<\/a>.<\/p>\n Dive Brief:<\/p>\n Two influential Democrat senators are investigating UnitedHealth over reports that the healthcare behemoth may be restricting care for nursing home residents in order to profit. Dive Insight:<\/p>\n In May, the Guardian published a bombshell investigation<\/a>\u00a0finding that UnitedHealth paid nursing homes lucrative bonuses if they reduced hospital transfers for residents in UnitedHealth insurance plans. Such arrangements are meant to prevent unnecessary hospitalizations by improving upstream care \u2014 but when kicked into overdrive can serve as a source of profits for insurers by paring back expensive inpatient claims.<\/p>\n UnitedHealth vehemently denied the Guardian\u2019s reporting and sued the outlet for defamation.<\/p>\n Still, Wyden and Warren called the report \u201calarming\u201d in their letter, and requested more information on UnitedHealth\u2019s institutional special needs plans, or I-SNPs: Medicare Advantage coverage for people dually eligible for Medicare and Medicaid living in skilled nursing facilities.<\/p>\n \u201cWe have outstanding questions about how [UnitedHealth\u2019s] programs are structured and their effects on patient safety,\u201d the two senators wrote.<\/p>\n The company\u2019s \u201cincentive schemes may drive delays in medically-necessary hospitalizations and emergency room visits, poor health care outcomes, and even permanent harm among enrolled residents who suffer strokes and other major health events without being hospitalized,\u201d Wyden and Warren said in the letter, adding that reporting also alleges that Optum pushed residents to sign orders that they not be resuscitated or intubated \u2014 steps that may hasten death but prevent hospitalization.<\/p>\n \u201cPut simply, these allegations suggest that [UnitedHealth] appears to be prioritizing its bottom line at the expense of the health and safety of nursing home residents enrolled in [UnitedHealth I-SNPs]. Nursing 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 letter reads.<\/p>\n The senators gave UnitedHealth until September 8 to respond to their list of roughly 50 questions.<\/p>\n UnitedHealth did not respond to a request for comment.<\/p>\n UnitedHealth \u2014 which operates the largest private insurer in the U.S., along with a major pharmacy benefit manager, large physician network and a bevy of other businesses \u2014\u00a0has found itself at the center of a maelstrom of public discontent over health insurers\u2019 business practices that restrict care. UnitedHealth is also facing lawmaker and regulatory scrutiny<\/a>\u00a0into how it may be preventing competition in healthcare markets, leveraging algorithms<\/a> to restrict care and gaming federal healthcare programs to bring in higher reimbursement.<\/p>\n
\nOn Wednesday,\u00a0Sens. Ron Wyden, D-Ore.,\u00a0and Elizabeth Warren, D-Mass., sent a letter to UnitedHealth requesting more information<\/a> after a briefing the company gave lawmakers on the issue late last month failed to assuage their concerns.
\nThe letter requests more information on UnitedHealth’s hospitalization policies, advance directive planning,\u00a0marketing strategies, and state and federal oversight of its plans.<\/p>\n