Allegations against UnitedHealth Group (NYSE: UNH) that it secretly paid nursing homes in order to reduce hospital transfers of residents under its Medicare Advantage (MA) plans are leading lawmakers on both sides of the aisle to increase calls for a federal investigation.

Last week, UnitedHealth filed a defamation lawsuit against the Guardian newspaper – whose investigation first shed light on the matter – accusing it of knowingly publishing false claims in its article that detailed the insurer’s alleged cost-cutting practices in nursing homes.

The article, part of a series titled, “Too Big to Care,” cited internal emails, documents, and interviews with over 20 current and former employees, asserting that UnitedHealth programs delayed or denied necessary emergency care.

The Guardian’s reporting included whistleblower claims that UnitedHealth paid bonuses to nursing homes to cut hospital transfers and used aggressive sales tactics to enroll vulnerable residents into its Medicare Advantage plans.

Moreover, two nurse practitioners, in sworn declarations, alleged that the company delayed or denied medically necessary emergency care to frail nursing home residents in order to cut costs and increase profits under its MA plans.

Maxwell Ollivant, a former UnitedHealth nurse practitioner who was named as one of the whistleblowers, filed a congressional declaration in May, asking the federal government to hold UnitedHealth accountable. He claimed that UnitedHealth “actively avoided medically necessary hospitalizations … to keep their costs down,” even in “life-threatening situations” and pressured patients into signing Do Not Resuscitate (DNR) and Do Not Hospitalize orders.

A second, anonymous whistleblower said the nation’s largest health insurer’s incentive systems and internal culture fostered “substandard care practices” and called its push for DNR orders “aggressive.”

UnitedHealth denied all allegations.

In an emailed statement to Skilled Nursing News, UnitedHealth’s spokesperson, Anthony Marusic, said, “The U.S. Department of Justice has already declined to pursue the matter. Furthermore, the article published by The Guardian is not only riddled with inaccuracies, it is so blatantly false and misleading that we have filed a defamation lawsuit to hold the publication accountable and bring the full truth to light.”

And, in an earlier statement to the Guardian, UnitedHealth countered that both whistleblowers lacked the expertise to evaluate the programs and that the lawsuits were dismissed or remain unproven.

“At no time have we encouraged or pushed” nursing home residents “to sign a DNR directive,” UnitedHealth told the Guardian, arguing that its nursing home programs delivered improved care through “on-site clinical care, personalized treatment plans, and enhanced coordination among caregivers.”

Despite UnitedHealth’s denials, lawmakers from both parties are demanding accountability.

Sen. Ron Wyden (D-Ore.) announced an investigation, stating, “This reporting demands further inquiry – nobody deserves to have their medical care jeopardized to pad insurance company profits.” And, Sen. Josh Hawley (R-Mo.) called the allegations “alarming,” while Rep. Buddy Carter (R-Ga.) said, “If these allegations are true, UnitedHealth must be held responsible for their gross abuse of patients.”

Meanwhile, Democratic Reps. Alexandria Ocasio-Cortez (N.Y.) and Lloyd Doggett (Texas) urged the Department of Justice (DOJ) to “thoroughly review” the whistleblower complaints and the Guardian’s reporting, which they say suggest “potential waste, fraud, and abuse at UnitedHealth.”

In a separate lawsuit, whistleblower Brook Gonite, a former UnitedHealth salesperson, alleged the company violated federal law by offering kickbacks to nursing homes for patient referrals and enrolling residents without proper consent. A federal judge denied UnitedHealth’s motion to dismiss, saying the complaint made “substantial and concerning” claims.

In addition, UnitedHealth’s practices under MA plans have previously been the subject of legal scrutiny. A federal lawsuit against UnitedHealth moved forward in February. The suit alleged the company’s AI tool, nH Predict, wrongly denied post-acute care – including for nursing home services – under MA plans without physician input or consideration of patients’ conditions.

UnitedHealth’s lawsuit against the Guardian

UnitedHealth has followed its statements of denial with a lawsuit in early June against the Guardian. Filed in Delaware Superior Court by UnitedHealth Group, UnitedHealthcare Services, and Optum, the suit alleges that the Guardian’s U.S. investigations team falsely reported that the company paid nurses to reduce hospital transfers for nursing home residents. 

UnitedHealth also claims that the Guardian’s reporting used “deceptively doctored documents” and “patently untruthful anecdotes,” a CNN story noted. The company further accused the publication of trying to “capitalize on the tragic and shocking assassination of UnitedHealthcare’s then-CEO, Brian Thompson.”

For its part, the Guardian strongly rejected the lawsuit, defending its reporting as “deeply-sourced” and based on extensive evidence, including corporate and patient records, federal filings, and company statements. The newspaper said it had received no request for corrections or retractions and condemned the lawsuit as an attempt to silence investigative journalism.

“It’s outrageous that in response to factual reporting … UnitedHealth is resorting to wildly misleading claims and intimidation tactics via the courts,” the Guardian stated.

UnitedHealth defends its I-SNP model

In a statement of denial issued in late May against the Guardian’s claims, UnitedHealth defended its nursing home partnerships and Institutional Special Needs Plans (I-SNPs) run by Optum, asserting that its programs improve care and comply with government standards.

UnitedHealth said that its payment arrangements were fully transparent and performance-based, tied to quality measures recognized by the Centers for Medicare & Medicaid Services (CMS).

These agreements, the company stated, were aimed at rewarding improved care outcomes, not to reduce hospital transfers improperly.

“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,” UnitedHealth’s statement read at the time.

The company also refuted claims that it pressured staff to avoid hospitalizing residents.

“At no time is UnitedHealthcare or Optum’s approval required when deciding whether to hospitalize,” the company stated, emphasizing that it encouraged collaboration with patients’ primary care providers and all care team members, and that unnecessary hospitalizations could be harmful for seniors, citing risks like delirium, pressure injuries, and functional decline.

UnitedHealth’s Optum division made headlines last year for workforce cuts, and for shutting down I-SNPs in several states, multiple sources told Skilled Nursing News.

In addressing claims it influenced end-of-life decisions, UnitedHealth insisted that it did not pressure residents into DNR orders. Instead, its care teams used training developed by Harvard’s School of Public Health to support patients and families in making informed decisions, with a focus on respecting autonomy.

And on its use of aggressive sales tactics, UnitedHealth said it did not offer incentives to nursing homes to enroll residents in specific plans and that its staff were trained in Medicare marketing compliance.