For SNF operators, the UnitedHealth nursing home payment investigation is directly relevant as it implicates the financial arrangements and hospitalization management practices embedded in I-SNP and embedded care team programs.
Medicare Advantage Quality Bonus Payments Will Total at Least $12.7 Billion in 2025
Federal spending on Medicare Advantage bonus payments will total at least $12.7 billion in 2025, similar to spending in 2023, and more than four times higher than in 2015. Since 2015, Medicare has spent at least $87 billion on quality bonus program payments.
Most Medicare Advantage enrollees (75%) are in plans that are receiving bonus payments in 2025. Since 2019, at least 7 in 10 Medicare Advantage enrollees have been in a plan receiving a bonus payment.
— KFF, Sept. 9, 2025
Revealed: UnitedHealth secretly paid nursing homes to reduce hospital transfers
A Guardian investigation finds insurer quietly paid facilities that helped it gain Medicare enrollees and reduce hospitalizations. Whistleblowers allege harm to residents
UnitedHealth Group, the nation’s largest healthcare conglomerate, has secretly paid nursing homes thousands in bonuses to help slash hospital transfers for ailing residents – part of a series of cost-cutting tactics that has saved the company millions, but at times risked residents’ health, a Guardian investigation has found.
Those secret bonuses have been paid out as part of a UnitedHealth program that stations the company’s own medical teams in nursing homes and pushes them to cut care expenses for residents covered by the insurance giant.
Senators launch ‘major’ investigation into UnitedHealth’s nursing home pay practices
— McKnight’s Long-Term Care News. August 15, 2025Senators probe UnitedHealth over Medicare advantage Hospitalization incentives for nursing homes
— Skilled Nursing News. August 7, 2025Nation’s largest Medicare Advantage insurer acknowledges federal investigations
— McKnight’s Long-Term Care News. July 24, 2025EXCLUSIVE | Prosecutors question doctors about UnitedHealth’s Medicare billing practices.
— WSJ. July 9, 2025UnitedHealth sues over ‘defamatory’ allegations related to nursing home, I-SNP practices.
— McKnight’s Long-Term Care News. June 13, 2025‘Alarming’: Lawmakers call for federal investigation of UnitedHealth’s alleged secret payments to nursing homes.
— Skilled Nursing News. June 11, 2025UnitedHealth accused of systematically denying nursing home patients needed hospital care
— McKnight’s Long-Term Care News. May 23, 2025UnitedHealth ‘Secretly paid’ nursing homes, Guardian reports, as UHG pushes back
— Skilled Nursing News. May 21, 2025
UnitedHealth stock tumbles as CEO resigns, 2025 outlook pulled
UnitedHealth Group CEO Andrew Witty abruptly stepped down from the health insurance and care conglomerate on Tuesday, citing personal reasons, capping the end of a tumultuous four-year tenure that included the killing of the company’s top insurance executive.
UnitedHealth named its board chair and former chief executive, Stephen Hemsley, as the company’s new leader. Hemsley — who was UnitedHealth’s CEO from 2006 to 2017 and is one of the most powerful people at the company — will remain the company’s chair.
UnitedHealth also announced it was suspending its 2025 profit outlook, saying “care activity continued to accelerate” and that “the medical costs of many Medicare Advantage beneficiaries new to UnitedHealthcare remained higher than expected.”
Medicare disadvantaged
— McKnight’s Long-Term Care News. May 27, 2025Exclusive | UnitedHealth Group is under criminal investigation for possible Medicare fraud.
— WSJ. May 15, 2025Leadership shakeup for UnitedHealth and Nursing Home I-SNP partner Optum after controversial 2024
— Skilled Nursing News. May 13, 2025UnitedHealth under criminal investigation for possible fraud in Medicare Advantage line: WSJ
— McKnight’s Long-Term Care News. May 16, 2025UnitedHealth cuts profit outlook by $3 billion as more Medicare patients get care
— STAT. April 17, 2025
Aetna, Elevance Health (Anthem) & Humana Accused of Paying Kickbacks to Brokers
About a third of enrollees seek help in making complex decisions about whether to enroll in original Medicare or select among private-sector alternatives, called Medicare Advantage.
Now a blockbuster lawsuit filed May 1 by the federal Department of Justice alleges that insurers Aetna, Elevance Health (formerly Anthem), and Humana paid “hundreds of millions of dollars in kickbacks” to large insurance brokerages — eHealth, GoHealth, and SelectQuote. The payments, made from 2016 to at least 2021, were incentives to steer patients into the insurer’s Medicare Advantage plans, the lawsuit alleges, while also discouraging enrollment of potentially more costly disabled beneficiaries.
Trump’s DOJ accuses Medicare advantage insurers of paying ‘Kickbacks’ for Primo customers
— KFF Health News. May 19, 2025Feds accuse insurers, brokers of steering older adults to certain MA plans regardless of suitability
— McKnight’s Senior Living. May 7, 2025
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