The UnitedHealth Group (Nasdaq: UNH) allegedly paid bonuses to nursing homes in order to reduce hospital transfers of residents under its Medicare Advantage (MA) plans, according to an investigation conducted by The Guardian.

The investigation revealed these cost-cutting practices saved the company millions, but endangered patient health; this included delayed or denied emergency hospital care. UnitedHealth denied wrongdoing, maintaining its MA program improves care and avoids unnecessary hospitalizations.

“The U.S. Department of Justice [DOJ] investigated these allegations, interviewed witnesses, and obtained thousands of documents that demonstrated the significant factual inaccuracies in the allegations,” UnitedHealth said in a statement to Skilled Nursing News. “After reviewing all the evidence during its multi-year investigation, the [DOJ] declined to pursue the matter.”

UnitedHealth refers to a DOJ fraud investigation into its Medicare practices, an active probe since last summer, according to a report from the Wall Street Journal.

UnitedHealthcare’s inappropriate leveraging of value-based arrangements, as The Guardian’s piece explores, did not enhance resident quality of life or care outcomes, Nicole Fallon, vice president of integrated services and managed care for LeadingAge, told Skilled Nursing News.

“That’s unfortunate: the market reality is that, when well-designed and deployed ethically, value-based arrangements can achieve two very important goals: improving outcomes for patients and compensating providers for care and services delivered,” Fallon said.

The bottom line, Fallon noted, is that providers need more options and MA plans need more oversight.

“This story underscores the urgent need for Medicare Advantage reform. We must do more to ensure older adults receive high-quality care without providers being placed under undue pressure or financial strain,” Fallon said.

Nisha Hammel, vice president of reimbursement policy and population health at the American Health Care Association and National Center for Assisted Living (AHCA) told Skilled Nursing News that leaders involved need to “refocus on the metrics that matter,” and that ultimately, medical professionals, patients and families need to be at the center of making clinical decisions moving forward.

Hammel added that preventative care and improving outcomes should be the primary goals of MA.

“The added benefit can and should be reducing overall health care costs but doing what’s best for residents is the focus of nursing home staff,” noted Hammel. “That includes preventing and reducing potentially avoidable hospitalizations because we know that they are often detrimental to frail seniors both physically and psychologically.”

Key findings from the Guardian investigation found there were secret incentives labeled as “premium dividends” or “shared savings” payments to nursing homes for keeping hospital admission rates low.

In multiple cases, residents showing strike symptoms weren’t promptly sent to hospitals as a result of the alleged UnitedHealth protocols; at least one resident suffered permanent brain damage, according to the investigation.

Nursing practitioners were also reportedly pressured to push for ‘do not resuscitate’ orders even when patients had not consented, in order to avoid costly interventions. Other key findings in the investigation involved sales tactics and privacy violations: nursing homes reportedly shared confidential patient data with UnitedHealth sales reps to enroll residents in its plans, sometimes without proper consent.

Patients and families weren’t aware of the financial incentives and cost-cutting measures that influenced their care.

Whistleblower and former nurse practitioner Maxwell Ollivant spoke about a culture of prioritizing cost over care, the investigation alleged. Ollivant filed a congressional declaration citing systemic denials of appropriate medical treatment. Staff were monitored and budgeted on how many hospital admissions were “allowed,” Ollivant said.

The allegations add to a laundry list of challenges for the company, following the abrupt departure of its CEO Andrew Witty last week, as well as the massive cyberattack at its Change Healthcare unit, and reports of criminal and civil investigations into the company’s practices, including Medicare fraud.

UnitedHealth’s shares tumbled again after the Guardian investigation was published. UnitedHealth shares closed at $302.98, a reduction of $18.60 or 5.78%.