UnitedHealth Group (Part 4)

This is Part4 of The Guardian’s investigation into UnitedHealth Group.

UnitedHealth promotes its nursing home programs as beneficial and offers residents access to UnitedHealth NPs both in person and remotely, which they claim will reduce “unnecessary” hospitalizations. This profits UnitedHealth, as these costly hospitalizations expose patients to further treatment, leading to increased costs for the company.

Looking back on 2019, a nursing home resident with stroke-like symptoms was delayed their hospital transfers after a UnitedHealth provider claimed the situation as less severe and recommended waiting four hours instead of an immediate transfer. The resident’s primary care doctor said that this delay may lead to long-term harm, and referenced another case where a nurse delayed the transfer of a stroke patient due to UnitedHealth protocols, which led to permanent impairments.

Despite UnitedHealth’s claim that it does not block hospital transfers, internal documents and interviews with former UnitedHealth employees suggest that the company pressures nursing home facility nurses into following UnitedHealth staff guidance, effectively shifting decision-making to them.

Former UnitedHealth employees describe their experience reflecting on the culture of resisting hospitalization. If they did not comply, they would face consequences. In one case, UnitedHealth reprimanded a nursing home for not consulting with their on-call team first before transferring a resident with stroke-like symptoms. However, this resident was admitted to the intensive care unit (ICU). UnitedHealth then scheduled training to “re-educate the facility’s nurses.”

A former UnitedHealth NP turned whistleblower opposed their argument by saying that these metrics overlook the damage done to patients who didn’t receive needed hospital care.

He said, “How many of those people were further harmed because they never received the care that they needed?”

Kevin Keep had recently found out that his father had suffered a possible stroke at a nursing home that was partnered with UnitedHealth. On February 23rd, 2019, Keep was experiencing forgetfulness and dropping on the right side of his face, similar to stroke-like symptoms. Instead of transferring Keep to the hospital, this remote UnitedHealth employee referred to a plan of providing aspirin and completing blood work for Mr. Keep.

According to a UnitedHealth doctor, this course of action “doesn’t make sense.” The doctor said, “That’s not useful when it might be a stroke,” and “What they really need is a physical exam and an MRI of the brain, and it needs to be done expeditiously.

The incident log suggested that the UnitedHealth team did not treat this case with the kind of urgency that a stroke requires.

The follow-up email from the company’s nurse practitioner stated that the work-up was for a “TIA,” which is a less serious neurological condition, not a stroke. After 18 hours, Keep was still found with his face drooping, while the work-up was still listed as “pending.” Again, UnitedHealth did not respond to an inquiry about whether the retiree was ever sent to the hospital.