Health insurance giant UnitedHealth Group used secret rules to restrict access to rehabilitation care requested by specific groups of seriously ill patients, including those who lived in nursing homes or suffered from cognitive impairment, according to internal documents obtained by STAT.
The documents, which outline parameters for the clinicians who initially review referrals for rehab care, reveal that many patients enrolled in Medicare Advantage plans were routed for a quick denial based on criteria neither they, nor their doctors, were aware of.
UnitedHealth kept the restrictions in place until early November, when managers abruptly told frontline clinical reviewers to stop following them and apply more of their own discretion, according to a current employee and internal documents. The directive to toss out the rules coincided with increased scrutiny of Medicare Advantage insurers from federal lawmakers and the Centers for Medicare and Medicaid Services, which will begin auditing their denials of medical services early next year. That scrutiny came after a series of STAT stories exposed UnitedHealth’s practices of pressuring employees to follow an algorithm to cut off care for sick and elderly people already in rehab.