{"id":174233,"date":"2025-06-10T23:58:08","date_gmt":"2025-06-10T23:58:08","guid":{"rendered":"https:\/\/www.europesays.com\/uk\/174233\/"},"modified":"2025-06-10T23:58:08","modified_gmt":"2025-06-10T23:58:08","slug":"unitedhealth-faces-federal-scrutiny-into-whistleblower-claims-us-healthcare","status":"publish","type":"post","link":"https:\/\/www.europesays.com\/uk\/174233\/","title":{"rendered":"UnitedHealth faces federal scrutiny into whistleblower claims | US healthcare"},"content":{"rendered":"

US lawmakers on both sides of the aisle are raising concerns and seeking investigations in the wake of Guardian reporting on whistleblower claims about practices within UnitedHealth Group\u2019s nursing home partnership programs.<\/p>\n

One US senator has announced he is launching an investigation and two US representatives are now calling on the US Department of Justice to expand<\/a> its reported investigations of the nation\u2019s largest healthcare conglomerate. Others said they are troubled by whistleblower allegations reported by the Guardian<\/a> \u2013 including claims that UnitedHealth paid bonuses to nursing homes to help reduce residents\u2019 hospital transfers and used improper sales tactics to get nursing home residents to sign up for the company\u2019s Medicare Advantage plans.<\/p>\n

Two Democratic members of Congress \u2013 representatives Alexandria Ocasio-Cortez of New York and Lloyd Doggett of Texas \u2013 filed a letter<\/a> on Monday that urges the Department of Justice to \u201cthoroughly review new revelations from investigative reporting and whistleblower complaints, which suggest that UnitedHealth may have engaged in illegal activities\u201d.<\/p>\n

\u201cThe Guardian\u2019s findings reveal the need for a wide-ranging investigation by the Department of Justice into years, if not decades, of potential waste, fraud, and abuse at UnitedHealth,\u201d the letter read.<\/p>\n

The lawmakers are demanding a briefing on current and planned investigations by 14 July.<\/p>\n

UnitedHealth vigorously denies<\/a> the whistleblowers\u2019 allegations and says the Guardian\u2019s reporting on these issues is \u201cblatantly false and misleading\u201d. In response to a question about the two representatives\u2019 letter, the company said the Department of Justice \u201chas already declined to pursue the matter\u201d \u2013 a reference to the agency\u2019s previous decisions not to intervene in two whistleblower lawsuits against UnitedHealth filed under the US False Claims Act. One of those lawsuits was ultimately dropped and the other is pending in federal court in Georgia.<\/p>\n

Another Democrat, the Oregon senator Ron Wyden, announced<\/a> last month on X that his office was \u201claunching a full investigation to verify these whistleblower accounts\u201d.<\/p>\n

\u201cThis reporting demands further inquiry \u2013 nobody deserves to have their medical care jeopardized to pad insurance company profits,\u201d Wyden, the ranking member of the Senate\u2019s finance committee, said. \u201cMy staff on the Finance Committee have a decade-long record of thorough and objective investigations that follow the facts towards solutions that improve federal health care policy for all Americans.\u201d<\/p>\n

Senator Josh Hawley, a Missouri Republican who sits on the Senate investigations subcommittee, said it is \u201calarming to hear these serious allegations\u201d about the company\u2019s practices. \u201cI look forward to securing justice for patients, policyholders and whistleblowers alike who\u2019ve been harmed by insurance companies.\u201d<\/p>\n

Another Republican, Georgia representative Buddy Carter, expressed similar concerns. \u201cIf these allegations are true, UnitedHealth must be held responsible for their gross abuse of patients,\u201d Carter, chair of the House subcommittee on health, said in a statement. \u201cPatients should always come before profits.\u201d<\/p>\n

Whistleblower a<\/strong>llegations<\/strong><\/p>\n

Senator Richard Blumenthal of Connecticut, ranking member of the Senate investigations subcommittee, said the \u201ccourage and conviction\u201d of the whistleblowers will serve as <\/strong>\u201c<\/strong>an impetus for reform. Shining a light on abuses of consumer trust is a call to action \u2013 and a demand for accountability.\u201d<\/p>\n

UnitedHealth says its partnerships with nursing homes ensure better care for seniors \u201cthrough on-site clinical care, personalized treatment plans, and enhanced coordination among caregivers\u201d. The company says these arrangements have been highly successful in helping nursing homes prevent unnecessary hospital stays that can lead to serious issues such as delirium, falls, pressure injuries and \u201csometimes even fatal consequences\u201d.<\/p>\n

Two whistleblowers who worked for UnitedHealth as nurse practitioners submitted sworn declarations in May alleging that the company had used improper tactics to reduce hospital transfers for ailing nursing home residents. Their declarations were submitted to the Securities and Exchange Commission (SEC), the Federal Trade Commission (FTC), the Washington state attorney general\u2019s office and Congress, according to Whistleblower Aid, the non-profit assisting both nurse practitioners.<\/p>\n

Whistleblower Maxwell Ollivant<\/a>\u2019s declaration, first reported on by the Guardian in May, says he witnessed UnitedHealth \u201cdelay and deny medically necessary emergency care\u201d to vulnerable nursing home residents in order to \u201cretain more money\u201d from the payments that the company was receiving from the US government\u2019s Medicare Advantage program.<\/p>\n

Under Medicare Advantage, a private alternative to traditional Medicare, the federal government pays insurers a fixed sum to cover seniors\u2019 medical services. The less insurers spend on covering medical expenses, the more in public dollars they have left over.<\/p>\n

Ollivant\u2019s declaration alleges that UnitedHealth \u201cactively avoided medically necessary hospitalizations \u2013 hospitalizations in serious life-threatening situations, or situations to avoid imminent death or incredibly catastrophic results \u2013 to keep their costs down, and drove vulnerable patients toward signing Do Not Resuscitate (DNRs) and Do Not Hospitalize orders to avoid providing hospital services for life threatening illnesses\u201d.<\/p>\n

UnitedHealth noted that the Department of Justice declined to join the lawsuit that Ollivant filed against the company and later dropped. The company said Ollivant \u201cis not in a position to assess the effectiveness of our programs \u2013 he lacks both the necessary data and the expertise\u201d.<\/p>\n

The second whistleblower, whose declaration was filed anonymously, worked with UnitedHealth for several years. Her declaration says her experiences as a nurse practitioner within its nursing home programs gave her \u201cfirst-hand insight into the evolution and impact of substandard care practices resulting from the training, culture, processes and bonus system of delays and denials of medically necessary care\u201d. That declaration criticizes the company\u2019s \u201c[a]ggressive [p]ush for DNRs\u201d and says \u201cthe decision to receive life-saving care should rest with the patient or their legal representative, not myself, and certainly not the insurance company\u201d.<\/p>\n

UnitedHealth said the allegations in the anonymous whistleblower\u2019s declaration show she \u201cdid not fully understand our clinical model\u201d and that her perspective \u201cdoes not reflect the dedication and excellence of the many outstanding clinicians who understand the impact they have in supporting their patients and improving health outcomes\u201d.<\/p>\n

The company also denies the claims regarding DNRs.<\/p>\n

\u201cAt no time have we encouraged or pushed\u201d nursing home residents \u201cto sign a DNR directive\u201d, a UnitedHealth representative said. \u201cOur health care providers are ethically bound to respect patient autonomy and support informed decision-making without coercion.\u201d<\/p>\n

The Guardian\u2019s previous reporting also references allegations relating to the legal claims of a third whistleblower, Brook Gonite, a former salesperson for UnitedHealth\u2019s nursing home program.<\/p>\n

Gonite alleges in a lawsuit in federal court in Georgia that UnitedHealth wrongly solicited and enrolled vulnerable, elderly patients for its nursing home programs through improper marketing tactics, including violations of Hipaa, the federal medical privacy act, and paid kickbacks to nursing homes to obtain illegal referrals of their residents.<\/p>\n

UnitedHealth denied those allegations and moved to dismiss Gonite\u2019s lawsuit. The Department of Justice, which declined to formally intervene in the case, opposed UnitedHealth\u2019s motion to dismiss.<\/p>\n

In April, federal judge Marc Treadwell denied UnitedHealth\u2019s motion to dismiss, finding that Gonite\u2019s lawsuit puts forth \u201csubstantial and concerning\u201d factual allegations that \u201cplausibly\u201d assert violations of federal protections meant to ensure vulnerable nursing home residents can make informed decisions about their medical care. The company continues to deny those claims and says Gonite was fired for engaging in illegal sales tactics similar to those alleged in his suit.<\/p>\n

In a statement, the company said its employees \u201care trained on compliant interactions with nursing home staff and nursing home residents, in accordance with the Medicare Marketing Guidelines and other applicable laws\u201d.<\/p>\n

Last week, shortly before the Guardian was to publish a second story providing additional detail about Gonite\u2019s pending lawsuit and the other two whistleblowers\u2019 declarations, UnitedHealth filed a lawsuit against the Guardian in Delaware state court, claiming the allegations were false and libelous. In a statement, the company said \u201cthe article published by The Guardian is not only riddled with inaccuracies \u2013 it is so blatantly false and misleading that we have filed a defamation lawsuit to hold the publication accountable and bring the full truth to light\u201d.<\/p>\n

The Guardian has said it stands by its \u201cdeeply sourced, independent reporting, which is based on thousands of corporate and patient records, publicly filed lawsuits, declarations submitted to federal and state agencies, and interviews with more than 20 current and former UnitedHealth employees \u2013 as well as statements and information provided by UnitedHealth itself over several weeks\u201d.<\/p>\n","protected":false},"excerpt":{"rendered":"US lawmakers on both sides of the aisle are raising concerns and seeking investigations in the wake of…\n","protected":false},"author":2,"featured_media":174234,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4316],"tags":[105,4348,16,15],"class_list":{"0":"post-174233","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-healthcare","8":"tag-health","9":"tag-healthcare","10":"tag-uk","11":"tag-united-kingdom"},"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@uk\/114661786530984614","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts\/174233","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/comments?post=174233"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/posts\/174233\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/media\/174234"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/media?parent=174233"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/categories?post=174233"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/uk\/wp-json\/wp\/v2\/tags?post=174233"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}