Profit First, Patients Last

A recent investigation by The Guardian has exposed a concerning pattern within the operations of UnitedHealth Group, the nation’s largest healthcare conglomerate. According to documents, interviews, and whistleblower accounts, the company has been quietly incentivizing nursing homes across the United States to reduce hospital transfers, sometimes at the expense of patient health. The practices, rooted in maximizing profits under Medicare Advantage plans, highlight not only systemic flaws in managed care but also the pressing need for universal healthcare reform in the United States.

At the center of this investigation is a UnitedHealth program that places the company’s medical staff inside nursing homes, allowing it to directly influence the level of care provided to residents. Through confidential contracts, the company has awarded financial bonuses to nursing homes that kept their hospitalization rates low. Internal terms like “Premium Dividend,” “Shared Savings,” and “Quality and Shared Risk” were used to describe incentive structures that rewarded facilities for cutting medical costs. Conversely, homes that failed to meet targets risked financial penalties, creating an environment where clinical decisions could be driven more by budget than by medical necessity.

Several troubling incidents were uncovered in which residents reportedly suffered harm due to delays in receiving hospital care. In one such case, a resident endured permanent brain damage following a delayed transfer. These outcomes raise concerns that corporate policies, even if framed as quality improvements, may in practice contribute to the denial or delay of essential medical care.

The Guardian’s reporting reveals that UnitedHealth employees were sometimes provided with informal “budgets” that tracked how many hospital admissions were permissible. The company also monitored the prevalence of “do not resuscitate” and “do not intubate” orders, which limit the extent of life-saving interventions. Former and current staff members stated that they were pressured to encourage changes in patients’ code status, even when those changes contradicted the wishes of the residents. While UnitedHealth denies coercing patients or blocking care, the collected documentation and firsthand testimonies suggest otherwise.

These findings emerge amid broader scrutiny of the Medicare Advantage system, which allows private insurers to receive fixed payments from the federal government for each enrollee. The incentive to spend less on care and retain the remainder as profit is baked into the structure of the program. While intended to control costs, the model can lead to perverse outcomes, particularly when financial considerations supersede medical ethics.

This investigation is a stark reminder of the limitations of a for-profit healthcare system where insurers can wield considerable influence over life-and-death decisions. The situation underscores the growing disconnect between corporate strategy and patient-centered care, especially in settings that house some of the most medically vulnerable individuals in the country. It also serves as yet another case in point for why serious discussion around universal healthcare in the United States is not just about access or affordability, but about accountability and oversight.

The implications of this reporting go far beyond one company or one program. As Medicare Advantage continues to grow and dominate elder care, the need for systemic reform becomes ever more urgent.

—By Greg Collier