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.
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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