Senators are pressing UnitedHealth Group (Nasdaq: UNH) over concerns that the company inappropriately encourages nursing homes to limit hospitalizations for residents enrolled in some of the company’s Medicare Advantage health plans.

The probe was launched by Sens. Ron Wyden (D-Ore.) and Elizabeth Warren (D-Mass.) following a May report in The Guardian alleging that UnitedHealth is jeopardizing patient health due to the way that the company distributes bonuses to nursing homes if they limit hospitalizations for certain patients enrolled in Medicare Advantage plans – specifically those enrolled in institutional special needs plans (I-SNPs).

As a result of these incentives, patients have experienced delays in medically necessary hospitalizations and emergency room visits, the report claimed. UnitedHealth also pushed residents to sign do-not-resuscitate and do-not-intubate orders, prohibiting hospitalization, according to the report.

Such business practices “imperil the health, safety, and lives of vulnerable seniors and people with disabilities living in nursing homes,” Sens. Warren and Wyden said in a Wednesday letter to UnitedHealth Group CEO Stephen Hemsley.

UnitedHealth has pushed back against such claims, including by filing a defamation lawsuit against The Guardian. The company “stands firmly behind the integrity of its institutional special needs plans,” Stat reported Thursday, in an article on the probe by Wyden and Warren.

‘Prioritizing its bottom line’

While UnitedHealth’s subsidiary, Optum, provided Congress with a briefing on these issues, the Senators said they have outstanding questions about how UnitedHealth’s I-SNPs are structured and their effects on patient safety.

“Put simply, these allegations suggest that UHG appears to be prioritizing its bottom line at the

expense of the health and safety of nursing home residents enrolled in UHG I-SNPs,” Warren and Wyden said in the letter. “Nursing home residents and their families should not live in fear of a for-profit health care company withholding care when it is most critical.”

The Senators called on UnitedHealth to provide full, written responses to its inquiries by Sept. 8. The inquiry dives into the UnitedHealth I-SNP care model, requests Optum policies governing hospital transfers for residents enrolled in a UnitedHealth I-SNP, and policies governing its “Premium Dividend” and “Shared Savings” programs.

I-SNPs represent an evidence-based model that aims to reduce unnecessary hospitalizations of nursing home residents, which the Senators support, but they said further research is needed to understand potentially negative outcomes associated with such a model, like higher rates of antipsychotic use, physical restraints, a decline in function and resident falls.

Latest in list of allegations

Other allegations against UnitedHealth include a problematic use of AI to deny care, highlighted in a separate lawsuit, and lack of proper oversight and potential pressure on patients regarding advance directives.

“Nursing home residents are often unable to advocate for themselves, and they frequently lack the support of family and other loved ones,” Warren and Wyden wrote. “Nursing home residents enrolled in I-SNP plans can be extremely medically frail and vulnerable, making it all the more critical that providers are clearly incentivized to place the needs of nursing home residents above profits.”

UnitedHealth defended its practices following The Guardian report, claiming the publication misrepresented the I-SNP program, also noting the Department of Justice (DOJ) found no wrongdoing in earlier reviews, despite ongoing investigation into other aspects of the company’s MA practices.

Reps. Alexandria Ocasio-Cortez and Lloyd Doggett have urged the DOJ to expand its investigation, claiming UnitedHealth’s business model breeds widespread waste, fraud and harm to patient health.