Whistleblowers Allege UnitedHealth Defrauds Medicare, Endangering Elderly Patients

What You Should Know: 

– Two whistleblowers, represented by Whistleblower Aid, have produced significant evidence alleging that Optum, a subsidiary of UnitedHealth Group (UHG), is engaged in a scheme to defraud Medicare by systematically delaying or denying critical hospital care to vulnerable nursing home patients.

– The allegations, submitted in a comprehensive disclosure to the Securities and Exchange Commission (SEC), the Federal Trade Commission (FTC), and Congress, have sparked bipartisan outrage and calls for federal investigations into the healthcare giant’s practices.

A “Playbook” for Putting Profits Over Patients

At the heart of the allegations is a UHC “playbook” that the whistleblowers, both former nurse practitioners with the company, claim pressures medical providers to prioritize cost-cutting over patient safety. The core of this strategy is to treat necessary off-site hospitalizations as “failures” on the part of the provider, as on-site nursing facility care is less costly for the insurer.

“Scores of elderly patients may never have received the care that they needed, all because UnitedHealthcare skimped on care to cut costs,” said Dr. Maxwell Ollivant, one of the whistleblowers. “UnitedHealthcare is compelling medical professionals to comply with its financially-driven playbook at the expense of patient safety in a way that pressures providers to violate their ethical obligations.”

Deceptive Practices and Dangerous Delays

The whistleblowers detail a series of shocking practices allegedly employed by UHC to minimize costs, including:

• Misleading Patients into DNRs: Caregivers were allegedly mandated to pressure elderly patients into signing “Do Not Resuscitate” (DNR) orders, sometimes by misleading them into believing their conditions were more severe than they were. UHC would then reportedly use these DNRs as justification for denying critical care.
• “Up-coding” Scheme: The disclosures corroborate previous reports of an “up-coding” scheme, where managers and staff were required to exaggerate patient conditions to claim more substantial capitated payments from Medicare Advantage.
• Delayed Critical Care: In one harrowing case, a UHC phone operator misdiagnosed a man experiencing a stroke. Despite the hospital being just five minutes away, the “playbook” was followed, and the patient was not admitted for over an hour, resulting in permanent neurological damage.

Retaliation and a Culture of Intimidation

The whistleblowers claim that UHC fostered a high-pressure culture to ensure compliance with its cost-cutting measures. When caregivers prioritized a patient’s life and hospitalized them, they allegedly had their compensation docked. This was often followed by a “grueling, manager-led, retrospective review” designed to blame the caregiver for the patient’s change in condition, further traumatizing them into complying with the UHC/Optum playbook.

Calls for Investigation

The serious nature of the allegations has drawn a swift and strong reaction from Washington D.C. A bipartisan group of lawmakers—including U.S. Senators Ron Wyden (D-OR), Josh Hawley (R-MO), and Richard Blumenthal (D-CT), and U.S. Representatives Alexandria Ocasio-Cortez (D-NY), Lloyd Doggett (D-TX), and Buddy Carter (R-GA)—have publicly raised concerns.

• Senator Ron Wyden, ranking member on the Senate Finance Committee, has announced his office will launch a full investigation into the claims.
• Representatives Ocasio-Cortez and Doggett are calling on the Department of Justice to investigate UnitedHealth for jeopardizing patient health and safety.

“This is exactly why whistleblowers matter. The greed described here shocks the conscience,” said Libby Liu, CEO of Whistleblower Aid. “I can’t imagine the unnecessary trauma these patients and their families endured… We support the ongoing investigations into the claims that UnitedHealthcare is maximizing their profits by trying to force medical providers to delay or deny life-saving care.”