Executive Summary
- Lawsuits allege UnitedHealth’s Optum unit delayed critical hospital care for nursing home residents, leading to deaths.
- Whistleblowers claim the company pressured staff to minimize hospital transfers to reduce insurance costs.
- Specific cases in Georgia, Ohio, and New York detail allegations of ignored medical emergencies.
- UnitedHealth denies the allegations, citing the medical benefits of treating patients in place and noting the DOJ declined to intervene.
UnitedHealth Group is facing multiple wrongful death lawsuits and whistleblower complaints alleging that employees of its Optum subsidiary delayed or denied critical hospital care to nursing home residents to reduce costs. The allegations assert that the healthcare conglomerate’s direct care unit, which places medical staff in nursing homes to manage residents insured by UnitedHealthcare, prioritized financial incentives over patient safety.
According to court filings and complaints lodged with state authorities, three nursing home residents died after Optum staff allegedly intervened to prevent hospital transfers. The lawsuits claim these interventions were part of a corporate strategy to curb "unnecessary" hospital admissions, which represent a significant expense for the insurance arm of the company. UnitedHealth has strongly denied these allegations, stating that its model is designed to protect fragile patients from the risks associated with hospital stays and that many claims are based on incomplete information.
In Georgia, the family of Cindy Deal, 58, filed a lawsuit alleging she died after Optum and nursing home staff failed to hospitalize her for hours despite symptoms indicating a seizure. An affidavit filed by a medical expert stated that Deal was found foaming at the mouth but was not transported until she was unresponsive. In Ohio, the family of Mary Grant, 70, alleged in a lawsuit that an Optum hotline employee denied a hospital transfer after Grant suffered a traumatic head injury from a fall. Grant subsequently died of a hematoma. A third complaint in New York alleges an Optum employee refused to hospitalize a resident with kidney failure, citing a preference for palliative care.
The litigation highlights the dual role UnitedHealth plays as both insurer and medical provider for approximately 55,000 long-term nursing home residents under Institutional Special Needs Plans (I-SNPs). Whistleblowers, including former Optum nurse practitioners, have alleged in declarations to Congress that they faced pressure to reduce hospital transfers and encourage "Do-Not-Resuscitate" orders to limit expenses. Former employee Maxwell Ollivant alleged that "STOP" signs were placed on patient charts to instruct staff to call Optum before independent doctors.
UnitedHealth has rejected the characterization of its practices, asserting that its clinical model leads to better health outcomes. "The insinuation that the desire to decrease unnecessary hospitalizations is motivated solely by financial considerations ignores well established evidence of the harm unnecessary hospitalizations can cause," the company stated. UnitedHealth noted that the Department of Justice declined to intervene in the whistleblower cases after reviewing the allegations.
Regulatory and Judicial Oversight
The lawsuits and complaints against UnitedHealth Group underscore the growing scrutiny surrounding the vertical integration of health insurers and care providers within the Medicare Advantage system. As insurers increasingly employ the clinicians responsible for approving care, legal experts and regulators are examining whether financial incentives inherent in capitated payment models create conflicts of interest that endanger patient safety. The outcome of these civil cases may influence future regulatory frameworks governing how insurers manage care delivery for high-needs populations in institutional settings. It is important to note that the claims made in these lawsuits are allegations, and UnitedHealth Group has not been found liable in the pending litigation.
