UC offers a privatized "Medicare Advantage" plan to retirees through UnitedHealth. Under Medicare Advantage plans, Medicare-eligible participants turn their Medicare benefits over to a private insurance company which is supposed to offer the same care as traditional federal Medicare. Over half of Medicare-eligible participants in the US are now in such privatized plans because they offer cheaper premiums and enticements such as gym memberships. In recent years, however, concerns have been raised that federal Medicare is overpaying the insurance providers and/or that the promised appropriate care is not always provided.
UnitedHealth, in particular, has received critical attention. From The Guardian:
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’s nursing home partnership programs. 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 its reported investigations of the nation’s largest healthcare conglomerate. Others said they are troubled by whistleblower allegations reported by the Guardian – including claims that UnitedHealth paid bonuses to nursing homes to help reduce residents’ hospital transfers and used improper sales tactics to get nursing home residents to sign up for the company’s Medicare Advantage plans...
UnitedHealth vigorously denies... whistleblowers’ allegations and says the Guardian’s reporting on these issues is “blatantly false and misleading”. In response to a question about the two representatives’ letter, the company said the Department of Justice “has already declined to pursue the matter” – a reference to the agency’s 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...
UnitedHealth says its partnerships with nursing homes ensure better care for seniors “through on-site clinical care, personalized treatment plans, and enhanced coordination among caregivers”. 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 “sometimes even fatal consequences”.
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’s office and Congress, according to Whistleblower Aid, the non-profit assisting both nurse practitioners...
Last week, shortly before the Guardian was to publish a second story providing additional detail about [a whistleblower's] pending lawsuit and the other two whistleblowers’ declarations, UnitedHealth filed a lawsuit against the Guardian in Delaware state court, claiming the allegations were false and libelous...
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