‘It’s a money game to them’: a son takes on UnitedHealth over his elderly father’s care

Robby Martin has joined a lawsuit against UnitedHealth after the insurance giant cut off his father’s nursing home coverage – five days later his father died at home. Two years ago, Robby Martin got an unsettling call from his father, Jackie. The 82-year-old told his son that a representative of the insurance giant UnitedHealth Group had barged into his nursing home room at 2.30 in the morning, announcing that he was going to be checked out at the end of the week.

Jackie Martin – who had been getting rehab at the nursing home after suffering a back fracture – still could not take more than a few steps without being out of breath. But Jackie’s care there, which had started two weeks earlier, was eating into UnitedHealth’s bottom line. The retired paper plant foreman was enrolled in UnitedHealth’s Medicare Advantage program, a federal privatization initiative that offers insurers a lump sum to cover services comparable to those under traditional Medicare. But the program’s pay structure means that the more care insurers deny, the more in taxpayer dollars they get to keep for themselves.

Now, UnitedHealth was pushing to terminate the 82-year-old’s rehab coverage. Jackie and his son appealed UnitedHealth’s decision and won. But the corporate giant issued another coverage termination letter the following week, then another one the week after that. Martin was a quiet man who didn’t like conflict. The repeated denials left him exhausted. “We talked and he said, ‘You know, I’m tired of this process every week. Let me just go home and see how I do,’” Robby recalled.

Soon after returning home, Jackie told his family he was no longer getting better and needed to find another care option. The next day – five days after UnitedHealth had cut off his nursing home coverage – he died alone in his bathroom. Send us a tip. If you are a current or former United Healthcare or Optum employee and have information you’d like to share securely with the Guardian about nursing home care, please use a non-work device to call or text investigative reporter George Joseph via the Signal messaging app at 929-486-4865.

Jackie’s battle with UnitedHealth during the final days of his life is now part of a lawsuit accusing the healthcare conglomerate of wrongfully denying elderly patients care owed to them under Medicare Advantage. His son Robby, who represents his late father’s estate, is now speaking publicly about his family’s experience with UnitedHealth for the first time. “They were just cutting him off because they could cut him off and reduce their expense,” Robby Martin said in an interview. “It’s all a money game to them.”.

Robby joined the ongoing suit last year, and is one of nine named plaintiffs, led by the Clarkson Law Firm, suing UnitedHealth in US district court in Minnesota. “There has to be some type of moral side to you that says, ‘This needs to be stopped,’” Robby Martin said. “And there needs to be a team of people that stop it.”. UnitedHealth Group and two of its subsidiaries did not respond to questions about the specific allegations made by Martin.

A spokesperson for Optum, one of UnitedHealth’s subsidiaries, said she could not discuss Martin’s case without a waiver releasing the company from federal health information protections. But in a statement, Optum said its “number one priority is ensuring patients receive the care they need”. “We believe this lawsuit has no merit and should be dismissed, as we have asked the court to do,” the statement declared, arguing that the company’s coverage decisions “are made by medical directors in accordance with Medicare coverage criteria for Medicare Advantage Plans ”.

Martin’s struggle to access care after a hospital visit is not a rare occurrence for older people enrolled in UnitedHealth’s Medicare Advantage program. In recent years, UnitedHealth has ramped up its efforts to deny care for older patients following strokes, falls and injuries that require rehab, according to an October 2024 investigation by the US Senate permanent subcommittee on investigations. The federal inquiry found that UnitedHealth’s prior authorization denial rate for post-acute care for older people on Medicare Advantage shot up from 8.7% in 2019 to 22.7% in 2022. For Medicare Advantage seniors seeking post-acute care in nursing homes specifically, UnitedHealth’s denial rate jumped up dramatically during that period, from 1.4% to 12.6%, amounting to more than 34,000 denials.

In a statement, the spokesperson for UnitedHealth’s subsidiary said the Senate committee investigation “mischaracterizes” Medicare Advantage and the company’s clinical practices while ignoring federal criteria “demanding greater scrutiny around post-acute care”. The corporate spokesperson also added that the company “ultimately” pays “98% of all claims” it receives, when they are submitted in “a timely manner with complete, non-duplicate information”.