UnitedHealth Group has issued a detailed response denying allegations that it deliberately delayed or denied care to elderly and nursing home patients as a cost-cutting measure.
The allegations stem from a whistleblower complaint which accuses the company of prioritizing financial savings over patient care.
The company pointed to a past federal inquiry, saying that the Department of Justice investigated the allegations, reviewed thousands of documents, and interviewed multiple witnesses before deciding not to pursue the case. It cited “significant factual inaccuracies” in the allegations as a key reason for the DOJ’s decision.
In a statement released this week, UnitedHealth addressed the claims, asserting that a report from The Guardian alleging Medicare fraud relies on anecdotal accounts and misrepresents the company’s healthcare programs.
Two former UnitedHealthcare nurse practitioners, represented by nonprofit legal group Whistleblower Aid, claim that the company operated with a so-called “playbook” that led to care being withheld from elderly patients.
They allege that UnitedHealthcare encouraged practices that intimidated healthcare providers and discouraged them from offering necessary medical treatment.
According to Whistleblower Aid, the whistleblowers contend the company’s internal policies resulted in delayed or denied care to reduce expenses and increase profitability. One of the former practitioners, Maxwell Ollivant, said that many elderly patients were left without necessary treatment because the company aimed to cut costs.
UnitedHealth responded that Ollivant was not in a position to assess the company’s programs and reiterated that the criticisms were anecdotal. It also noted that Ollivant later withdrew his lawsuit voluntarily.
The company also denied specific claims regarding hospitalization and patient transfers. It said its business, including Optum, never required prior approval for hospital admissions, countering allegations that patients were left without emergency care due to bureaucratic delays.
One of the more serious claims involves reports that elderly patients were misled into signing do-not-resuscitate (DNR) orders under the impression that their conditions were terminal.
UnitedHealth denied this, stating that it does not promote or pressure members into signing DNR orders. The company said its providers are required to support informed, voluntary decisions aligned with ethical and legal standards.
Another allegation, reported by Whistleblower Aid, concerned a stroke patient whose symptoms were allegedly misdiagnosed by a UnitedHealth call center operator, resulting in a delayed hospital admission and long-term neurological harm.
UnitedHealth rejected the suggestion that such outcomes were due to systemic requirements, saying that providers are not required to seek company approval before making hospitalization decisions.
UnitedHealth also rejected the claim that it used financial incentives to influence decisions at skilled nursing facilities. It said all payments to these facilities are governed by contracts that reimburse for services and include performance-based incentives tied to quality outcomes.
Separate from these whistleblower claims, UnitedHealth is also facing legal action involving its use of artificial intelligence in care decisions. A lawsuit alleges that the company used an algorithm known as nH Predict to reject or limit coverage for post-acute care services like skilled nursing stays, without adequate consideration of patients’ health needs.
The developments come amid broader turbulence at the company, with UnitedHealth’s stock declining more than 50% since April. The drop follows heightened regulatory scrutiny and leadership changes, including the resignation of CEO Andrew Witty and the return of former CEO Stephen Hemsley (pictured above).
The company has faced past legal challenges over its Medicare billing practices. In 2017, the US government filed a complaint alleging that UnitedHealth submitted inflated risk adjustment claims by overstating patients’ health conditions to secure higher payments.
What are your thoughts on this story? Please feel free to share your comments below.
