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Whistleblowers Accuse UnitedHealthcare/Optum of Medicare Fraud, Denying Critical Care to Nursing Home Patients – HIT Consultant
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What You Should Know:
– Less than a week after the resignation of UnitedHealth Group (UHG) CEO Andrew Witty, two whistleblowers have come forward with significant evidence alleging that Optum, a subsidiary of UnitedHealthcare (UHC), is engaged in dangerous and deceptive practices amounting to defrauding Medicare.
– The accusations detail a purported “playbook” employed by UHC that systematically delays or outright denies critical care to vulnerable nursing home patients to reduce costs and maximize profits.
– Represented by Whistleblower Aid, the two former UHC nurse practitioners have submitted a comprehensive disclosure of these allegations to the Securities and Exchange Commission (SEC), the Federal Trade Commission (FTC), the Washington State Office of the Attorney General, and the U.S. Congress, demanding a thorough investigation. The disclosure claims the company intimidated and bullied medical providers into denying patients access to essential care.
The Alleged “Playbook”: Profits Over Patient Well-being in Nursing Homes
The whistleblowers describe a system where UHC allegedly implemented unconscionable cost-cutting measures, including the avoidance of even necessary hospitalizations for emergencies, to the detriment of vulnerable patients. According to the allegations, because off-site care and hospitalizations are more costly for the health insurer than care within a nursing facility, UHC designed its “playbook,” training materials, and rewards system to discourage such external care. This culture reportedly frames off-site care as a failure on the part of the provider, encouraging delays in critical care and refusal of hospitalizations, while rewarding providers who comply with these cost-saving measures, allegedly at the expense of patient well-being.
Disturbing Examples of Alleged Care Denial and Misleading Practices
The disclosure includes disturbing specific examples of care allegedly denied or delayed in nursing homes. In one instance, a patient vomiting fecal-like matter was reportedly denied hospitalization by UHC. Despite a nurse suspecting potentially fatal gastrointestinal bleeding, the concerns of both the nurse and the patient were allegedly ignored by UHC.
Another case detailed involves a UHC phone operator, who was off-site and had no direct contact with the patient, allegedly misdiagnosing a man experiencing a stroke. Though the hospital was only five minutes away, the patient was not admitted for over an hour due to adherence to UHC’s playbook, resulting in permanent neurological damage, including slurred speech.
Furthermore, the whistleblowers claim that UHC materials mandate caregivers to pressure elderly patients into signing “Do Not Resuscitate” (DNR) orders. This was allegedly done by misleading patients into believing their conditions were worse than they were, including suggesting imminent death, in an effort to use these DNR orders to keep patients out of hospitals and minimize costs for UHC.
“Up-Coding” Scheme and Retaliation Against Providers Alleged
Beyond care denial, Whistleblower Aid clients also reportedly witnessed an “up-coding” scheme dictated by UHC training. This scheme allegedly required managers and staff to exaggerate patient conditions to falsely claim more substantial reimbursements from Medicare Advantage.
The whistleblowers also assert that when they prioritized patient safety and did hospitalize a patient to save their life, UHC docked their compensation. This was allegedly followed by a “grueling, manager-led, retrospective review” aimed at blaming the caregiver for the patient’s change in condition, further pressuring caregivers into complying with the UHC/Optum playbook.
A Call for Accountability
One of the whistleblowers, Dr. Maxwell Ollivant, a nurse practitioner formerly employed by UHC, stated, “Scores of elderly patients never received the care that they needed, all because UnitedHealthcare skimped on care to cut costs. UnitedHealthcare is compelling medical professionals to comply with its financially-driven playbook at the expense of patient safety, forcing providers to violate their ethical obligations. I’d like to see them held accountable for putting profits over patients”.
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UnitedHealthcare’s Mounting Challenges – What It All Means for Nurses – Nurse.org
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The past several months have brought a cascade of negative headlines for UnitedHealthcare, the nation’s largest health insurer. As nurses on the front lines of patient care, these developments directly impact your work, your patients, and the broader health system. Here’s a comprehensive look at the recent events shaking UnitedHealthcare—and what they might mean for you.
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Just today, an investigation by The Guardian revealed that UnitedHealthcare allegedly paid secret bonuses to nursing homes to discourage hospital transfers for sick residents, particularly those enrolled in Medicare Advantage plans. The alleged intent? To reduce costs by minimizing expensive hospitalizations.
In December, UnitedHealthcare’s CEO Brian Thompson was shot and killed in New York City—a shocking event that sent ripples throughout the healthcare industry and among executives generally. Luigi Mangione was indicted for the killing and recently pleaded not guilty. Since these events, there has been additional turbulence:
Just last week, UnitedHealthcare CEO Andrew Witty resigned abruptly, citing “personal reasons”. The company simultaneously withdrew its financial forecast for 2025, blaming surging medical costs and “unforeseen changes” in its operations.
Adding to the turmoil, WSJ reported last week that the Department of Justice is investigating UnitedHealthcare for possible criminal Medicare fraud, focusing on its Medicare Advantage business. Allegations include:
UnitedHealthcare is also facing an ongoing, high-profile class-action lawsuit from 2023 alleging that it used artificial intelligence tools to deny claims for post-acute care under Medicare Advantage plans. That lawsuit advanced in February of this year when a judge reduced the number of claims, but allowed it to proceed.
UnitedHealthcare’s ongoing crises are a powerful reminder that nurses must continue to advocate for ethical care, patient safety, and system-wide accountability.
From the bedside to the boardroom, your voice matters. Stay informed, speak up, and engage in shaping a healthcare future rooted in transparency and compassion.
Nurse.org will continue to update this article as more information becomes available.
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How to build emotional strength and stop taking things so personally – Times of India
The TOI Lifestyle Desk is a dynamic team of dedicated journalists who, with unwavering passion and commitment, sift through the pulse of the nation to curate a vibrant tapestry of lifestyle news for The Times of India readers. At the TOI Lifestyle Desk, we go beyond the obvious, delving into the extraordinary. Consider us your lifestyle companion, providing a daily dose of inspiration and information. Whether you're seeking the latest fashion trends, travel escapades, culinary delights, or wellness tips, the TOI Lifestyle Desk is your one-stop destination for an enriching lifestyle experience.
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Some WHOOP Users Are Experiencing Serious Device Issues – InsideHook
The memorably-named fitness wearables company WHOOP has experienced tremendous growth in the last few years, reaching a $1.2 billion valuation in 2021. By earlier this year, that valuation had effectively tripled. In a 2024 post on LinkedIn, founder and CEO Will Ahmed addressed the importance of being a subscription-based company.
“As a subscription, we need to win the business of our existing members every day, every week, every month, every year,” Ahmed wrote. Thus far, WHOOP’s customers seem largely satisfied — but an issue has recently come into focus with the WHOOP 5.0 and the WHOOP MG, two new wearables launched earlier this month.
On Friday, Android Police’s Karandeep Singh Oberoi reported that some of the new devices were ceasing to function properly for their buyers. According to the report, WHOOP buyers were experiencing serious issues and took to the company’s online forums to share their frustration. This, in turn, led WHOOP to send out new devices to at least some of the people who were affected.
Android Police cited one email from the company to a device owner: “We’ve noticed your WHOOP may not be syncing as it should. We have proactively sent you replacement WHOOP right away.”
In comments made to Engadget’s Ian Carlos Campbell, a spokesperson for WHOOP stated that the device issues were not widespread, and were “rare and isolated, impacting a small number of members.” They added that they were not charging subscribers for the time they spent without a functional fitness wearable.
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Local roundup: Carleton to play in Prague; Konecny leads Canada in scoring – Chatham Daily News
The WNBA season has just begun, but Chatham’s Bridget Carleton already has a team for the next EuroLeague Women season.
The WNBA season has just begun, but Chatham’s Bridget Carleton already has a team for the next EuroLeague Women season.
She’ll head to Czechia after the WNBA campaign to play for defending champion ZVVZ USK Praha.
“I’m really excited to join ZVVZ USK next season,” Carleton said in a statement. “I’ve always respected the club and its amazing fans, and I can’t wait to arrive in Prague and start working toward another great season.”
She ended the last EuroLeague season in April by playing for Turkey’s CBK Mersin in a championship-game loss to Praha.
On Wednesday, Carleton had nine points, six rebounds and three assists as the WNBA-leading Minnesota Lynx improved to 3-0 with an 85-81 win over the Dallas Wings in Minneapolis.
She’s averaging 6.7 points, 6.7 rebounds and 2.7 assists per game.
Clachan’s Travis Konecny assisted on Canada’s goal in a 2-1 quarter-final loss to Denmark at the IIHF men’s world championship Thursday in Herning, Denmark.
Denmark scored the tying goal with 2:17 left in the third period and scored again with 49 seconds left in regulation.
“We did not do the things that we did all tournament to have success,” Team Canada head coach Dean Evason said. “It came back to bite us, and obviously this is a devastating loss. We needed to be better in all areas, but unfortunately we were not. It is tough to swallow, and it is very frustrating and disappointing to come this far and fall short.”
Konecny, of the Philadelphia Flyers, is tied for the tournament lead with 10 assists in eight games. His 13 points also tied Nathan MacKinnon for the team lead.
Fellow Chatham-Kent AAA Cyclones alumnus Brandon Montour, of the Seattle Kraken, leads all defencemen at the tournament with nine points in eight games. He led the Canadian skaters in the quarter-final with 23:24 of ice time.
New York Islanders forward Bo Horvat, whose father, Tim, is from Bothwell, had eight points in six games for Canada.
The Chatham-Kent Barnstormers will host two games this weekend at Fergie Jenkins Field at Rotary Park in the Intercounty Baseball League.
They’ll play the Brantford Red Sox Saturday at 7:05 p.m. and the Guelph Royals Sunday at 2:05 p.m.
Friday’s game at the Hamilton Cardinals was postponed because of poor field conditions after a rainstorm. No makeup date was announced.
The Barnstormers have a 1-1 record after last weekend’s home-and-home split with the Kitchener Panthers.
The defending champion Ursuline Lancers will host the Lambton Central Lancers in the LKSSAA senior girls’ rugby final Monday at 4 p.m.
Ursuline won its semifinal by forfeit Thursday over Chatham-Kent.
Lambton Central is the only LKSSAA team to take the field this season against Ursuline, which won five of six matches by forfeit.
Ursuline beat Lambton Central 59-0 in their lone match.
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NATIONAL PHYSICAL FITNESS AND SPORTS MONTH, 2025 – The White House (.gov)
BY THE PRESIDENT OF THE UNITED STATES OF AMERICA
A PROCLAMATION
During National Physical Fitness and Sports Month, we celebrate the foundational role that physical fitness and sports play in helping us to live longer, healthier, and more fulfilling lives. Through sports, fitness routines, and staying active, we have the opportunity to improve our health, strengthen our communities, and build a brighter future for our country.
For far too long, our Nation has failed to prioritize the health and well-being of the American people. This negligence has come at a devastating cost. As a result, the United States lags behind other developed countries in life expectancy, chronic disease prevention, and overall public health outcomes.
This era of indifference ended when I took office. I was proud to appoint Robert F. Kennedy, Jr. as the Secretary of Health and Human Services to urgently confront and stop this crisis. I also established the Make America Healthy Again Commission, tasked with ensuring Americans have access to nutritious food choices, while addressing the root causes of childhood chronic diseases. With public health as a cornerstone of my Administration, we are forging a future where the American people are healthier and stronger than ever before.
Engagement and active participation in sports, especially among our youth, is vital to fostering a culture of health and physical fitness. My Administration is committed to ensuring that our sports and competitive spaces remain safe, free, and accessible for future generations of Americans. In my first term, I signed an Executive Order to nationally expand children’s participation in sports, promoting physical activity, fitness, and the academic and social benefits of healthy lifestyles. I was also proud to recently sign an Executive Order to keep biological men out of women’s sports, ensuring our female athletes are free to compete and excel on a level and fair playing field.
Together, we are building a healthier and more flourishing Nation, one that champions physical fitness and well-being, empowering every citizen to reach their full potential and excel in all aspects of life.
NOW, THEREFORE, I, DONALD J. TRUMP, President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim May 2025 as National Physical Fitness and Sports Month. I call upon the people of the United States to incorporate physical fitness and sports participation into their everyday lives.
IN WITNESS WHEREOF, I have hereunto set my hand this twenty-fourth day of May, in the year of our Lord two thousand twenty-five, and of the Independence of the United States of America the two hundred and forty-ninth.
DONALD J. TRUMP
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Pennsylvania Launches Women’s Health Insurance Awareness Survey – Franklin County Free Press
In recognition of Women’s Health Month, Pennsylvania’s healthcare agencies are conducting a statewide survey to assess women’s understanding of their health insurance coverage and the no-cost benefits available to them.
The survey, available in English, Spanish, and Chinese through July 7, asks women about their awareness and use of covered services such as maternal care, mental health screenings, contraception, cancer screenings, and sexually transmitted infection screenings and treatment. These services are typically covered without cost under the Affordable Care Act.
The initiative is led by the Pennsylvania Insurance Department in coordination with the Department of Health, Department of Human Services (DHS), and the Department of Drug and Alcohol Programs (DDAP). The goal is to identify obstacles women face in accessing care and improve awareness of insurance-covered services.
The state also provides support for uninsured or underinsured women through programs like the Pennsylvania Breast and Cervical Cancer Early Detection Program, which offers free screenings. Additionally, a recently passed bill in the House would require insurance coverage for follow-up imaging after the detection of breast abnormalities.
Expanded Medicaid coverage now includes doula services and extends postpartum care from six weeks to one year. According to a 2024 Department of Health report, most pregnancy-associated deaths occur within this extended postpartum period, with mental health conditions being the leading cause.
Maternal mortality among Black women and women with substance use disorders remains a concern, prompting targeted programs and investments from state agencies.
For more information or to participate in the survey, visit the Pennsylvania Insurance Department website.
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