Statement Regarding May 21 Article in The Guardian

Claim:

UnitedHealthcare uses secret bonus payments to influence care decisions at Skilled Nursing Facilities.

Reality:

• There is nothing secret about our programs with Skilled Nursing Facilities.
• Our payments to nursing facilities are structured through contracts that not only reimburse for member services but also incentivize high-quality outcomes.
• A portion of these payments is tied to the facilities’ performance on industry-recognized quality measures, rewarding efforts that lead to improved care.
• These agreements incorporate the same evidence-based clinical quality criteria used by CMS in its value-based care programs.
• CMS has repeatedly recognized that unnecessary hospitalizations drive high costs to the health care system and are dangerous for long-term care residents.

Claim: 

UnitedHealthcare created pressure to avoid hospitalizations.

Reality: 

• The suggestion that UnitedHealthcare or Optum employees prevented transfers to the hospital is verifiably false.
• At no time is UnitedHealthcare or Optum’s approval required when deciding whether to hospitalize.
• Any suggestion that Optum or its nurse practitioners prevent facilities from contacting the patient’s primary care provider to get his or her perspective on what to do when a patient is experiencing a change in condition, is false. In fact, we encourage facilities to collaborate with all members of the patient care team, including, of course, the patient’s PCP.
• The I-SNP clinical model is designed in part to fulfill CMS’s and OIG’s long-standing goal of avoiding unnecessary, costly, and potentially harmful hospitalizations in favor of providing appropriate clinical care in the appropriate setting.
• Unnecessary hospitalizations pose real risks. Hospital-associated complications (HACs) are a significant and well-documented issue in acute hospital stays for elderly adults. These complications, which include delirium, functional decline, falls, incontinence, and pressure injuries, are prevalent and detrimental to patient outcomes.
• The quality of care delivered by I-SNPs is monitored and rated through the CMS Star Ratings system. The 2024 Star Ratings show UnitedHealthcare I-SNP health plans achieved very high ratings.

Claim:

UnitedHealthcare tries to Influence End-of-Life Decisions.

Reality:

• At no time have we encouraged or pushed a member to sign a DNR directive.
• Our health care providers are ethically bound to respect patient autonomy and support informed decision-making without coercion.
• Evidence has shown that advanced care planning has a positive impact on the quality of end-of-life care. 
• Our Serious Illness Conversation training comes from gold-standard materials developed by the Harvard School of Public Health and Ariadne Labs, a joint center for health systems innovation at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health whose stated goal is "for every seriously ill patient to have more, better, and earlier conversations with their clinicians about their goals, values, and priorities that will inform their future care.”  Our clinicians dedicate hours to learning these materials to help patients and their families through this process.

Claim:

UnitedHealthcare offered financial incentives to nursing homes to enroll residents in the I-SNP program.

Reality:

• Optum and UnitedHealthcare do not offer financial incentives to SNFs to enroll patients in specific plans.
• Company employees are trained on compliant interactions with nursing home staff and nursing home residents, in accordance with the Medicare Marketing Guidelines and other applicable laws. The company requires that facilities comply with Marketing Guidelines and other applicable laws.  

Claim: Whistleblower Declarations

• Statements from former employees alleging substandard care and pressure to avoid hospitalizations, referencing lawsuits United States ex rel. Maxwell Ollivant v. Optum et al. and United States ex rel. Gonite v. UnitedHealthcare of Georgia Inc. et al.

Reality:

• Mr. Ollivant and Mr. Gonite are not in positions to evaluate our programs. 
• Our position is supported by peer-reviewed studies and measurable outcomes. In contrast, the criticisms being raised are based on anecdotes.
• The Department of Justice has already investigated these allegations, interviewed witnesses, and obtained thousands of documents that demonstrated significant factual inaccuracies in the allegations. The Department of Justice elected not to pursue either case. Mr. Ollivant voluntarily dismissed his lawsuit.
• We stand firmly behind the integrity of our programs, which consistently receive high satisfaction ratings from our members.

Claims:

Reports UnitedHealthcare delayed or denied hospital care for patients showing stroke symptoms and other critical conditions.

Reality:

• At no time is UnitedHealthcare or Optum’s approval required when deciding whether to hospitalize.