Democratic Sens. Ron Wyden (Oreg.) and Elizabeth Warren (Mass.) are launching an investigation into UnitedHealth Group (UHG) over its actions reportedly steering seniors away from hospital visits for the sake of chopping prices.
In a letter to UHG CEO Stephen J. Hemsley, Wyden and Warren cited reporting from shops together with The Guardian that stated his firm was paying nursing houses to cut back hospital transfers of sick sufferers.
The senators wrote that UHG representatives instructed them bonus applications for nursing houses are supplied to encourage “adherence to certain quality measures.”
Considered one of these applications permits for nursing houses to obtain bonuses in the event that they attain sure ranges of influenza and pneumococcal vaccination charges and ldl cholesterol treatment adherence charges, whereas additionally sustaining a hospital admission per thousand price beneath a sure threshold.
Additionally they pointed to UHG institutional particular wants plans, offered by way of its subsidiary Optum, which reportedly disincentivize “medically-necessary hospitalizations and emergency room visits.” These plans additionally reportedly stress nursing residence residents to signal “do not resuscitate” (DNR) and “do not intubate” (DNI) orders.
On the time of The Guardian’s reporting in Could, UHG denied it was stopping hospital transfers or pushing sufferers to signal DNRs and DNIs.
“Put simply, these allegations suggest that UHG appears to be prioritizing its bottom line at the expense of the health and safety of nursing home residents enrolled in UHG 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,” the lawmakers wrote.
Although they expressed their assist for evidence-based fashions that scale back “unnecessary hospitalizations of nursing home residents,” Wyden and Warren famous a briefing with UHG representatives didn’t resolve their considerations surrounding these studies.
The lawmakers requested data on UHG’s I-SNP mannequin, Optum’s insurance policies on transferring residents on I-SNP to the hospital in addition to data on its bonus applications.
“Any attempt to take advantage of vulnerable nursing home residents is unacceptable, especially to pad a for-profit insurance company’s revenues. It is vital that UHG respond to these alarming reports and provide prompt, detailed responses to our questions,” wrote Wyden and Warren.
