Senate report slams Medicare Advantage insurers for using predictive technology to deny claims

Healthcare DIVE October 21, 2024
Susanna Vogel

UnitedHealth, CVS and Humana used technology to increase MA prior authorization denials for post-acute services, boosting profits, according to a report for a Senate subcommittee.

Dive Brief:

• A new Senate report sharply criticizes the country’s three largest Medicare Advantage insurers — UnitedHealthcare, Humana and CVS — for allegedly limiting access to post-acute care to maximize profits.
• The insurers leveraged algorithmic tools to sharply increase claims denials for MA beneficiaries between 2019 and 2022, according to the report published Thursday by the Senate Permanent Subcommittee on Investigations. They most often denied coverage to patients in nursing homes, inpatient rehab hospitals and long-term hospitals, the report found.
• MA payers have previously come under fire from lawmakers for using algorithms to determine...

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