Medicare Advantage Insurers Used Technology to Help Deny Claims: Senate Report

The nation’s three largest Medicare Advantage insurers increasingly refused to pay for rehabilitation care for seniors in the years after they introduced advanced technologies to support their coverage decisions, a Senate investigation found.

UnitedHealth Group, Humana and CVS Health focused on denials among older adults seeking care in nursing homes, inpatient rehabilitation hospitals and long-term hospitals. As of 2022, these three insurers denied about a quarter of all requests for post-acute care among their Medicare Advantage enrollees, according to the congressional report.

The report, prepared by the U.S. Senate Permanent Subcommittee on Investigations, extensively cites STAT’s series from last year examining the use of algorithms and artificial intelligence within Medicare Advantage plans. The series focused on how UnitedHealth and its subsidiary NaviHealth used unregulated algorithms to predict when someone might be cut off from rehabilitation care. For example, STAT’s investigation showed how UnitedHealth pushed employees to adhere to the algorithm’s predictions even when patients could barely walk and weren’t ready to go home.