Texas Attorney General Probes UnitedHealth Over Allegations It Paid Nursing Homes to Delay Hospital Care for Patients

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VICTORIA JONES | POOL | AFP via Getty Images Share on Twitter Share on Facebook Share on Pocket Texas Attorney General Ken Paxton has opened an investigation into UnitedHealth Group, citing reports that the insurer paid nursing homes to delay hospitalizing patients who needed medical care. In a release from the Texas Attorney General’s office dated Oct. 5, 2026, Paxton said he issued Civil Investigative Demands to the company to examine possible violations of the Texas Deceptive Trade Practices Act and other state laws. No charges have been filed, and none of the allegations have been proven.

For families with a parent or grandparent in a nursing home in Houston, Dallas, San Antonio, Austin, or elsewhere in the state, the question is personal. When a frail resident suddenly runs a fever, becomes confused or struggles to breathe, the decision to call an ambulance can matter within hours. The investigation asks whether financial arrangements may have influenced that decision.

UnitedHealth has strongly denied similar claims about its nursing home programs in the past. MedicalDaily has reached out to UnitedHealth Group for comment on the Texas investigation. Becker’s Hospital Review also reported that it had contacted the company and had not received a statement as of publication on Oct. 5.

According to the attorney general’s office, the investigation covers several concerns. The release cites reports that United bribed nursing homes to delay necessary hospitalizations. It also describes a case in which United allegedly approved a procedure at RedBud Surgery Center in Austin, then withdrew that approval by letter after the procedure took place, leaving the patient with a large medical bill.

Paxton’s office is also examining whether United’s coverage decisions may amount to the corporate practice of medicine by overriding the medical judgment of treating physicians and directing patient care. “Alarming reports keep piling up about how United treats Texas consumers. I will not tolerate any insurance company putting illegal corporate greed over the people of Texas,” Paxton said in the release.

A Civil Investigative Demand is a legal tool that lets a state attorney general require a company to hand over documents, records or written answers before deciding whether to sue. Receiving one does not mean a company broke the law, and the release does not list which specific records Texas requested.

The probe follows a separate investigation Paxton’s office opened in late September into Blue Cross and Blue Shield of Texas and its parent company, Health Care Service Corporation, over possible care denials, delays and prior authorization problems, Becker’s reported.

The nursing home allegations trace back to a May 21, 2025, Guardian investigation. That report alleged that UnitedHealth placed staff in about 2,200 nursing homes nationwide and paid facilities bonuses tied to lower hospital admission rates, according to Becker’s coverage of the Guardian report. The Guardian also cited an internal email describing “budgets” for hospital admissions.

UnitedHealth rejected those claims. In a company statement responding to the Guardian, it said: “The U.S. Department of Justice investigated these allegations, interviewed witnesses, and obtained thousands of documents that demonstrated the significant factual inaccuracies in the allegations. After reviewing all the evidence during its multi-year investigation, the Department of Justice declined to pursue the matter.” The company also said its nursing facility payments are structured through contracts, with a portion tied to quality measures, and that UnitedHealthcare or Optum approval is never required to hospitalize a patient.

UnitedHealth sued the Guardian for defamation. In July 2026, a judge in Delaware dismissed that suit, finding the core reporting “substantially true,” Becker’s Payer Issues reported. In January 2026, Sens. Ron Wyden and Elizabeth Warren pressed the company for more records. A spokesperson responded, “We categorically reject any assertion that UnitedHealth Group or Optum engage in practices that endanger patient safety or violate ethical standards,” Fierce Healthcare reported.

MedicalDaily previously reported on a Senate request for records on post-hospital care denials by Medicare Advantage insurers.

Not every hospital trip helps a nursing home resident. UnitedHealth has argued that avoiding unnecessary hospitalizations protects older adults from complications.

The concern raised by the allegations is different. Residents often live with several chronic conditions, and an infection, a fall, or a heart problem can worsen quickly. The CDC describes sepsis as “a life-threatening medical emergency,” and its warning signs include confusion or disorientation, fever or shivering, a high heart rate or weak pulse, shortness of breath, and clammy or sweaty skin. In those situations, a delay in transfer could limit treatment options.

It remains unconfirmed whether any Texas nursing homes took part in the programs described in the earlier reporting, or whether any Texas resident was harmed. Those are among the questions the state’s demands may help answer. The residents with the most at stake are older adults in UnitedHealth’s Medicare Advantage plans, people with dementia who cannot describe their symptoms, and those without a family member nearby to advocate for them.

Families do not need to move a loved one based on these allegations alone. A practical step is to ask the facility who makes transfer decisions, how quickly a physician is contacted after a change in condition, and whether your relative’s insurance plan has staff working inside the building.

Families can ask for a hospital evaluation when they believe a resident is seriously ill. If a resident shows signs of sepsis, stroke, chest pain, or trouble breathing, call 911 or insist on an emergency transfer. Patients who face a reversed prior authorization or a surprise bill can ask their insurer for the decision in writing, file an appeal, and keep copies of every notice.

Next steps rest with the attorney general’s office, which has not announced a timeline for reviewing UnitedHealth’s response. The state could later sue or close the inquiry. MedicalDaily will update this story if UnitedHealth comments or Texas announces further action. For now, the allegations remain unproven, but families can stay alert and speak up when a loved one’s condition changes.

What is Texas investigating UnitedHealth Group for?

The Texas attorney general’s office is examining reports that UnitedHealth paid nursing homes to delay necessary hospitalizations, withdrew a prior approval after a procedure in Austin, and overrode physicians’ medical decisions. These are allegations, and no court has found wrongdoing.

It is a legal order that requires a company to provide documents or information to a state attorney general during an investigation. It allows officials to gather evidence before deciding whether to take legal action, and it is not a finding that the law was broken.

How has UnitedHealth responded to the nursing home allegations?

UnitedHealth has denied earlier versions of the claims, saying the Justice Department reviewed them and declined to pursue the matter. The company said its payments are contract-based and partly tied to quality and that its approval is not required for hospital transfers. MedicalDaily has reached out to the company for comment on the Texas investigation.

Why can a delayed hospital transfer be dangerous?

Many nursing home residents are frail and have several health conditions, so an infection or other illness can worsen quickly. The CDC calls sepsis a life-threatening medical emergency, which means prompt care can matter.

The investigation is statewide. Families of nursing home residents enrolled in UnitedHealth’s Medicare Advantage plans may want to follow it closely, although officials have not confirmed any Texas facility’s involvement.

Ask the nursing home how it decides on hospital transfers and how quickly it notifies families. Request an emergency evaluation if a loved one shows severe symptoms, and keep written records of any insurance denials or reversed approvals.