UnitedHealth Group shares dropped as much as 7.5% in premarket trading Wednesday in New York, following a Guardian investigation that revealed the health insurer shelled out "Premium Dividend" and "Shared Savings" bonuses to nursing homes that reduced hospital transfers for sick residents.
The Guardian's investigation is based on thousands of confidential corporate and patient records obtained through sources, public records requests, and court filings, along with interviews with nearly two dozen current and former UnitedHealth and nursing home employees, as well as two whistleblower declarations submitted to Congress.
The report offers a new snapshot into UnitedHealth's daily operations at nearly 2,000 nursing homes across the country, where it manages Medicare Advantage coverage for more than 55,000 long-term residents.
Here are some of the key findings from the report:
UnitedHealth stationed in-house medical teams at nearly 2,000 nursing homes, incentivizing them to lower hospitalizations through financial rewards like "Premium Dividend" and "Shared Savings" payments tied to hospitalization rates.
Internal records show UnitedHealth monitored nursing homes using "admits per thousand (APK)" metrics and set "budgets" for hospitalizations. Facilities with high APKs were denied bonuses.
In multiple documented cases, patients were denied urgent hospital care, leading to serious harm, including permanent brain damage. Whistleblowers say these incidents were hidden or minimized.
Nurse practitioners were pressured to push "Do Not Resuscitate" (DNR) orders, even when patients had previously expressed the desire for life-saving treatments.
UnitedHealth also incentivized increased enrollment in its Institutional Special Needs Plans by offering large payments to nursing homes, which in some cases leaked confidential patient data to help sales teams directly solicit families—often bypassing consent rules.
The Guardian noted:
In several cases identified by the Guardian, nursing home residents who needed immediate hospital care under the program failed to receive it, after interventions from UnitedHealth staffers. At least one lived with permanent brain damage following his delayed transfer, according to a confidential nursing home incident log, recordings and photo evidence.
A current UnitedHealth nurse practitioner, who recently submitted a congressional complaint regarding the nursing home program, stated:
"No one is truly investigating when a patient suffers harm. Absolutely no one.
"These incidents are hidden, downplayed and minimized. The sense is: 'Well, they're medically frail, and no one lives for ever.'"
A former national UnitedHealth executive said:
"APK drove everything. 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."
Two current and three former UnitedHealth nurse practitioners said that UnitedHealth managers pressured them to persuade Medicare Advantage members to change their "code status" to DNR, even when patients had clearly expressed a desire to receive all available life-saving treatments.
UnitedHealth responded to the Guardian's report, rejecting claims that its employees have prevented hospital transfers.
The Guardian's report comes at a time of crisis for UnitedHealth. Last week, shares logged the worst weekly crash since 1998 after a Wall Street Journal report said the Department of Justice has been conducting a criminal investigation into the company's Medicare practices. In addition, UnitedHealth suspended its 2025 outlook, and its CEO abruptly exited.
In the premarket session, shares fell as much as 7.5% after the Guardian's report.
Only one Wall Street analyst—CFRA's Paige Meyer—had a "Sell" rating on UnitedHealth earlier this year, out of roughly 30 tracked by Bloomberg. Wall Street, it seems, was overly bullish on the insurer—now shares have imploded.
