Medicare Advantage insurers used technology to help deny claims: Senate report

A Senate investigation found that the nation’s three largest Medicare Advantage insurers increasingly refused to pay for rehabilitative care for seniors in the years after they adopted sophisticated technologies to help with their coverage decisions .

UnitedHealth Group, Humana and CVS Health led denials among seniors seeking care at nursing homes, inpatient rehabilitation hospitals and long-term care hospitals. As of 2022, those three insurers were turning down about a quarter of all post-acute care requests among their Medicare Advantage enrollees, according to the congressional report.

The report, conducted by the US Senate Permanent Subcommittee on Investigations, extensively cites last year’s STAT series that investigated 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 from rehab care. STAT’s investigation revealed, for example, how UnitedHealth pushed employees to meet the algorithm’s predictions, even if patients could barely walk and weren’t ready to go home.