UnitedHealth’s Nursing-Home Model Cut Hospital Trips — Now Faces Wrongful-Death Suits and Whistleblower Claims

Families, a clinician and multiple former employees have alleged that clinicians from UnitedHealth Group’s clinical arm, Optum, helped delay or deny hospital care that preceded three nursing-home deaths. The claims, made in wrongful-death lawsuits, whistleblower declarations and a state complaint, focus attention on a controversial model in which an insurer also provides on-site clinical care inside long-term care facilities.

Overview

UnitedHealth places nurse practitioners and physician assistants from Optum inside nursing homes to care for residents enrolled in its institutional special needs plans (I-SNPs), a form of Medicare Advantage. UnitedHealth says the model reduces unnecessary hospital transfers that can harm frail residents; critics say financial incentives tied to Medicare Advantage may create pressure to avoid necessary hospital care.

The Cases Alleging Harm

Cindy Deal (Georgia): Deal, 58, was found foaming at the mouth and unresponsive. Her family says Optum and nursing-home staff delayed hospital transfer for hours; Deal was later pronounced dead. The family has sued, and the nursing home settled separately while Optum remains a defendant and denies wrongdoing.

Mary Grant (Ohio): Grant, 70, fell from her wheelchair and hit her head the day before she began vomiting and was low on oxygen. Nursing-home staff contacted an Optum hotline instead of immediately hospitalizing her; recordings and notes produced in litigation show an Optum clinician advised treating in place. Grant was found dead the next day and her family filed a wrongful-death suit alleging failure to transfer her for imaging and surgical evaluation.

Allegation Reported by Christopher Bieniek (New York): Christopher Bieniek, a physician assistant working for an independent medical group, filed a complaint alleging an Optum clinician refused to transfer a 63-year-old resident with kidney failure and symptomatic low blood pressure; Bieniek supplied investigators with text messages he says corroborate his account. UnitedHealth disputes elements of the complaint and has said family members sometimes requested palliative approaches.

Whistleblowers and Internal Concerns

At least four former employees have submitted whistleblower complaints or declarations alleging managerial pressure to reduce hospital transfers, encourage advance directives such as Do-Not-Resuscitate/Do-Not-Hospitalize orders, and use diagnosis coding to increase Medicare payments. Former Optum clinicians describe seeing protocols that required nursing homes to call Optum first and said some staff received incentives tied to lower transfer rates.

One former Optum nurse practitioner, Maxwell Ollivant, filed internal complaints, resigned, and later submitted declarations to federal and state authorities. Others, including sales employees, have alleged improper marketing practices in nursing homes; some of those claims have proceeded in court while UnitedHealth has denied misconduct and said it disciplines employees who violate policies.

UnitedHealth's Response

UnitedHealth has repeatedly denied that Optum staff endangered patients or improperly steered clinical decisions for financial gain. The company says reducing unnecessary hospitalizations is clinically supported because hospital stays can cause delirium, falls and pressure injuries in frail residents. UnitedHealth provided utilization data: between July 2024 and June 2025, its long-term nursing-home members experienced about 38,000 emergency-room transfers and 16,000 hospital admissions, and the company says nearly half of those admissions were initiated without Optum involvement.

The company also says a Department of Justice review produced documents it believes undermine whistleblower claims; UnitedHealth did not provide documentation to reporters in response to requests. The insurer has sued media outlets for defamation over coverage of the program and defends its care model and training materials, citing external guidance and quality scores.

Policy Context And Stakes

Medicare Advantage pays insurers a fixed amount per enrollee. When insurers deliver care more efficiently, they can retain unspent funds as profit, which some lawmakers and experts say can create a real or perceived conflict of interest. Policy experts note that avoiding unnecessary hospitalizations benefits many frail residents but stress safeguards are needed so clinical judgment — not cost incentives — determines transfers.

"You don’t want to then overcorrect and basically align the incentives so that people are never sent to the hospital when they really need to go," said Gretchen Jacobson of the Commonwealth Fund.

Legal And Regulatory Fallout

Senators Ron Wyden and Elizabeth Warren sought documents and briefed with UnitedHealth after press reports. Multiple lawsuits and complaints are pending, including wrongful-death suits from the Deal and Grant families, whistleblower actions from former employees, and a complaint Bieniek filed with New York state authorities. Some claims remain in litigation; UnitedHealth continues to contest the allegations.

Conclusion

The disputes highlight a growing tension in U.S. health care: integrated insurers that both pay for and provide care can create efficiencies — but also raise questions about how financial and clinical incentives interact. As courts and regulators review the allegations, the central issues will be whether Optum’s protocols preserved clinicians’ independent judgment and whether policies adequately protected vulnerable nursing-home residents from under-treatment or inappropriate marketing practices.