UnitedHealth does many things, including selling Medicare Advantage plans, private insurance to replace publicly funded Medicare. It is a massive company facing equally massive allegations and problems, including those in a recent Guardian article. If a loved one is a nursing home resident who has UnitedHealth coverage and was injured because they weren’t transferred to a hospital for appropriate care quickly enough, or not at all, they may have grounds to file a personal injury action.
Big Company Faces Big Accusations
UnitedHealth Group’s stock value peaked in 2024 at more than half a trillion dollars ($561.99 million). It sells insurance and healthcare services. Fortune lists it as the eighth biggest company on the planet (by revenue) this year, behind Apple but bigger than Berkshire Hathaway. According to the list, it’s making more money than Exxon Mobil, Shell, or Toyota. UnitedHealth is estimated to earn more than twice what Ford Motor Co. does.
But as of May 2025, the company’s stock value is down to $266.22 billion, according to Macrotrends. It’s facing many challenges, including a massive federal audit of payments it received for its Medicare Advantage patients, a reported federal criminal investigation, and allegations by the Guardian that it paid nursing homes bonuses if they kept those it covers out of the hospital.
An Insurer Could Save a Lot of Money if Nursing Home Residents Don’t Go to the Hospital
UnitedHealth Group is the country’s biggest healthcare company, according to the Guardian. It has secretly paid nursing homes bonuses to lower residents’ hospital transfers, among other tactics, to cut costs and save the company millions of dollars.
If a nursing home can’t meet a resident’s medical needs, and a physician isn’t on-site, it should transfer them to the nearest hospital for a proper diagnosis and treatment. But this kind of care is much more expensive than what’s provided at a nursing home, and these costs lower an insurance company’s profitability.
There are also risks if a resident is unnecessarily sent to a hospital. They could be injured while being transported, suffer an infection at the hospital, or be subject to inappropriate medical care there.
These bonuses are part of a company program that puts its employees physically in nursing homes. They’re not just available on the phone or through the internet. These employees are accused of pushing nursing home management and staff to cut care costs for covered residents.
The Guardian claims it found several cases where nursing home residents needing immediate hospital care failed to receive it after UnitedHealth intervention. One suffered permanent brain damage after showing signs of a stroke. UnitedHealth staff instructed a nursing home employee to determine whether he’d suffered something else, delaying a hospital transfer for several hours at a time when every minute is critical to avoiding brain injuries.
UnitedHealth Gets a Set Amount for Its Residents. That Incentivizes Medical Neglect
A current company nurse practitioner alleges these situations aren’t being investigated and the company is hiding, downplaying, and minimizing them. Given they’re medically frail to begin with, the company is accused of treating residents as disposable with a limited shelf life.
The Guardian states UnitedHealth has inserted itself into the daily operations of nearly 2,000 nursing homes. This helps them secure federal dollars from Medicare Advantage plans covering more than 55,000 nursing home residents. The company is also accused of pressing nursing homes to violate confidentiality laws by giving them information about residents UnitedHealth doesn’t cover to help sign them up for coverage.
Under Medicare Advantage, the federal government gives carriers like UnitedHealth a lump sum for each person covered. The more care the person gets, the higher the costs, the less profit the company earns. UnitedHealth denied that its employees prevented hospital transfers. It claims it’s trying to prevent unnecessary hospitalizations that are costly and potentially dangerous to patients.
Over the past seven years, UnitedHealth has paid nursing homes “Premium Dividend” and “Shared Savings” payments. Through another program, the company offered more money if nursing homes drove down medical spending enough, but threatened to take it back if they failed to do so.
UnitedHealth executives are allegedly obsessed with their “admits per thousand” (APK) metric, which measures the rate nursing homes send residents to hospitals. A low APK results in nursing home bonus payments, while a high APK results in nothing. Denying care meant more money for both UnitedHealth and the nursing home.
UnitedHealth is Accused of Telling Residents that Death Isn’t So Bad
Another way to prevent a hospital admission is to have residents refuse to go. The company kept track of nursing homes with small percentages of patients with “do not resuscitate” (DNR) and “do not intubate” orders in their files. Through these orders, patients state they don’t want medical care if something catastrophic happens to them, shortening their lives.
Two current and three former UnitedHealth nurse practitioners allegedly told the Guardian that company managers pressured nurse practitioners to convince Medicare Advantage residents to get DNR orders even if patients clearly stated they wanted all available treatments to keep them alive.
Get the Legal Help You Need in KentuckyIf you or a family member is injured due to neglect or negligence by nursing home staff, whether they have UnitedHealth coverage or not, we can help. Call the Fleck Firm at (270) 446-7000 or contact us online to schedule a free consultation. We’ll discuss what happened, the injuries, how the law may apply, and your best options to proceed. Insurance companies have lawyers. You should have one, too.
