UnitedHealth’s Secret Bonus Program: A Profit-Driven Threat to Nursing Home Residents

A new Guardian investigation has revealed that UnitedHealth Group, the country’s largest health insurer, quietly paid nursing homes across the U.S. to keep residents out of hospitals — even in cases where hospitalization was medically necessary. The scheme, designed to slash costs and maximize profits under the Medicare Advantage program, has allegedly caused permanent harm to residents while families remained in the dark.

At Brown & Barron, LLC, we’ve long fought to expose the dangerous effects of prioritizing profits over people in America’s nursing homes. This latest report is yet another harrowing example of how corporate greed continues to put vulnerable seniors at risk — and why families must demand accountability.

How UnitedHealth’s Bonus Program Worked

According to the Guardian, UnitedHealth created a covert system of incentive payments that rewarded nursing homes for reducing hospital transfers. These included:

• Premium Dividend and Shared Savings bonuses for nursing homes that kept "admissions per thousand" (APK) low.
• Financial clawbacks for homes that failed to meet APK targets.
• Internal pressure on UnitedHealth nurse practitioners to delay or block hospital transfers.
• Tracking and pressuring staff regarding DNR (do not resuscitate) orders to reduce the likelihood of hospital-level interventions.

In practical terms, UnitedHealth embedded its own medical personnel into nearly 2,000 nursing homes, enabling it to influence medical decisions that should have been made by independent doctors. The company then used its leverage to push treatment decisions that lowered costs — even when those decisions conflicted with residents’ medical needs.

Tragic Outcomes: Delayed Transfers, Lasting Harm

The report documented multiple disturbing cases:

• A resident in Renton, Washington, showing signs of a stroke, was denied immediate hospitalization. Her independent physician was never informed.
• Another stroke victim in Puyallup, Washington, suffered permanent slurring and facial paralysis after hospitalization was delayed.
• A resident in Bremerton, Washington, showed classic stroke symptoms, but UnitedHealth staff opted to "wait and monitor" instead of transferring him for an MRI. His condition went untreated for more than 18 hours.

Each of these cases involved vulnerable residents and facilities participating in UnitedHealth’s Institutional Special Needs Plans (ISNPs), which offer financial rewards for keeping patients within the facility, regardless of whether outside medical care is urgently needed.

What Residents & Families Were Never Told

Perhaps most shocking: residents and their families were never informed that financial incentives were tied to life-or-death care decisions.

Whistleblowers, including former UnitedHealth practitioners, told the Guardian that internal protocols and pressure to meet financial targets often took priority over patient outcomes. One practitioner reported being penalized for failing to stop a hospital transfer, even after the resident was admitted to an ICU for a brain bleed.

As one whistleblower stated:

“You gain profitability by denying care, and when profitability suffers for the shareholders, that’s when people get crazy and do things that are not appropriate.”

Profits First, Patients Last

What the Guardian uncovered is not an isolated incident — it’s part of a larger, systemic issue in the elder care industry, where profit-seeking facilities have allowed understaffing and neglect to run rampant. Medicare Advantage plans like UnitedHealth’s are designed to reward cost-cutting. And when the same company responsible for paying for care also controls the care being delivered, vulnerable seniors pay the price.

It’s a system where:

• Corporations receive lump sums from Medicare, then profit by denying care.
• Nursing homes are pressured to suppress hospitalizations to receive bonuses.
• Medical teams are incentivized to follow business protocols over best medical practices.
• Families are kept in the dark until it’s too late.

At Brown & Barron, LLC, we believe this is nothing short of exploitation.

Brown & Barron, LLC: Holding the Industry Accountable

For years, our firm has helped families stand up to nursing home chains, managed care organizations, and for-profit operators who value shareholder returns over the well-being of residents. We understand how corporate incentives corrupt care, and we’ve successfully fought in nursing home abuse and neglect cases to expose dangerous practices that lead to:

• Medical mismanagement
• Delayed or denied hospital care
• Understaffing and neglect
• Improper use of DNR orders
• Preventable injuries, permanent harm, and wrongful death

If your loved one suffered harm at a nursing home — especially if they were denied hospital treatment or enrolled in a Medicare Advantage plan without clear consent — we want to hear your story.

We’re here to fight for justice, accountability, and long-overdue change in an industry that continues to treat residents as revenue — and safety as a secondary concern.

Call (410) 698-1717 or contact us online to request a FREE consultation.