Medicare Advantage insurers ramped up use of technology to deny claims, Senate investigation shows

By Bob Herman and Casey Ross

Oct. 17, 2024

The nation’s three largest Medicare Advantage insurers increasingly refused to pay for rehabilitative care for seniors in the years after adopting sophisticated technologies to aid in their coverage decisions, a Senate investigation found.

UnitedHealth Group, Humana, and CVS Health targeted denials among older adults who were requesting care in nursing homes, inpatient rehab hospitals, and long-term hospitals. As of 2022, those three insurers were turning down roughly a quarter of all requests for post-acute care among their Medicare Advantage enrollees, according to the congressional report.

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The report, conducted by the U.S. Senate Permanent Subcommittee on Investigations, extensively cites STAT’s series last year that investigated the use of algorithms and artificial intelligence within Medicare Advantage plans. The series focused on how UnitedHealth and its subsidiary NaviHealth were using unregulated algorithms to predict when someone could be cut off from rehab care. STAT’s investigation revealed, for example, how UnitedHealth pushed employees to abide by the algorithm’s predictions, even if patients could barely walk and were not ready to go home.

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1. 

   Bob Herman

   Business of Health Care Reporter

   Bob Herman covers health insurance, government programs, hospitals, physicians, and other providers — reporting on how money influences those businesses and shapes what we all pay for care. He is also the author of the Health Care Inc. newsletter.

2. 

   Casey Ross

   Chief Investigative Reporter, Data & Technology

   Casey Ross covers the use of artificial intelligence in medicine and its underlying questions of safety, fairness, and privacy.

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