Medicare Advantage plans ‘intentionally using prior authorization to boost profits’: Senate report

Becker's Healthcare October 17, 2024
Jakob Emerson

The largest Medicare Advantage insurers have prioritized profits over patient care by increasing the use of prior authorization in recent years to frequently deny post-acute care services to older adults, according to a report published Oct. 17 by the Senate Permanent Subcommittee on Investigations.

As the use of prior authorization has grown, insurers have increasingly deployed predictive technologies and artificial intelligence tools to influence their decisions, often prioritizing financial savings over medical necessity, according to the report.

“There is a role for the free market to improve the delivery of healthcare to America’s seniors, but there is nothing inevitable about the harms done by the current arrangement. Insurers can and must do better, for the sake of the American healthcare...

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