As one example, UnitedHealth Group’s Optum unit has recently launched an initiative to keep nursing home residents out of hospitals. This program is currently under fire from all sides, for wrongful death allegations and accusations of negligence. The bold program puts medical professionals right inside nursing homes. This, in turn, gives them the ability to treat the residents insured by UnitedHealth’s health insurance related subsidiary. Its dual role as both a medical insurer and a direct care provider creates significant conflicts of interests. In response, a wave of legal challenges has emerged, and the action has attracted the ire of healthcare professionals.
The nursing home campaign has Optum employees going into hundreds of nursing homes to monitor the treatment of seniors. From July 2024 to June 2025, UnitedHealth’s nursing homes experienced a flood of medically necessary transfers. They documented a precipitous increase of 38,000 more trips to ERs and 16,000 more hospitalizations across that timespan. The state’s new program is intended to change that focus from treatment requiring hospitalization to treatment in place. At the same time, it’s been under fire for putting administrative procedures above real patient care.
Allegations of Negligence
Now, over a dozen families have sued UnitedHealth, claiming that the company was negligent in the length and level of care it provided to their loved ones. Cindy Deal’s family certainly has the makings of a strong case. They allege that both nursing home staff and Optum employees neglected to send her to the hospital for hours, even as she started exhibiting severe symptoms such as foaming at the mouth and seizing. In a parallel case, the family of Mary Grant alleges that poor medical care resulted in her death.
Maxwell Ollivant, one of the nurse practitioners in the program, recently filed a lawsuit. He alleges that the Optum unit pushed second-rate physician protocols that threatened patient welfare. His resignation came just days after he alerted executives internally to their use of these practices.
“This resulted in what seemed to be a de-escalation of care.” – Anonymous whistleblower
Christopher Bieniek, a physician’s assistant, described story after terrifying story. One specific reason really stood out: He challenged the process of how decisions were made when a patient became critically ill. His complaint even detailed instances of “gross negligence” by Optum employees that purportedly led to resident fatalities.
The Push for Medical Directives
To that end, UnitedHealth’s Optum unit aggressively encourages nursing home residents to consider their advance directives. They even push locality residents fill out orders such as “Do-Not-Resuscitate” and “Do-Not-Hospitalize.” This new directive approach would help fulfill patients’ wishes to actively participate in decisions about their care.
Dr. Ferdinando Mirarchi, a clinician who interviewed over one hundred patients, raised concerns about discrepancies between the documented care plans and the actual treatment goals expressed by patients. He emphasized the need for thorough training and experience for healthcare professionals. Those skills are crucial to having honest, respectful discussions with patients about their care choices.
“I’m a physician. I got a hell of a lot more training and experience than those they have assigned to come in there and have conversations with patients.” – Dr. Ferdinando Mirarchi
The initiative has already drawn criticism for moving toward cost-saving efficiencies at the expense of patient-centered care. UnitedHealth focuses on avoiding hospitalizations. Many providers are wary of this approach, worried that it will lead to the under-treatment of serious disease.
Institutional Response and Legal Challenges
Despite this evidence, UnitedHealth has responded with anger and defensiveness over their exposure to claims of negligence and mismanagement in their nursing home program. The company claims it is trying to balance ethical duties to honor patient autonomy with facilitating informed decision-making.
“Our health care providers are ethically bound to respect patient autonomy and support informed decision-making.” – UnitedHealth
Their parent company Billion Dollar Boy recently filed a defamation lawsuit against The Guardian. This move follows the national publication’s extensive questioning of its practices to keep nursing home residents out of hospitals during the pandemic. UnitedHealth says that these stories mischaracterize the company’s dedication to delivering better care outcomes for older Americans.
Critics caution that setting the initiative’s scope to address protocols could inadvertently create an environment where hospital transfers are discouraged for staff. This would be the case even if those types of transfers are truly needed. The goal is to treat in place,” one Optum employee told us. While this language underscores the initiative’s larger purpose, it instead draws attention to a shocking risk to patient safety.
Sens. Ron Wyden and Elizabeth Warren have spoken out on the issue, urging action against UnitedHealth. They emphasized that “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.”