A recent Senate investigation revealed that the three largest Medicare Advantage insurers in the nation, including UnitedHealth Group, Humana, and CVS Health, have been increasingly denying claims for rehabilitative care for seniors. This denial trend began after these insurers adopted advanced technologies to assist in their coverage decisions.
Specifically, the insurers targeted claims for older adults seeking care in nursing homes, inpatient rehab hospitals, and long-term hospitals. The report indicated that as of 2022, approximately 25% of all requests for post-acute care among Medicare Advantage enrollees were being denied by these three insurers.
The U.S. Senate Permanent Subcommittee on Investigations conducted the report, which extensively referenced STAT’s previous series investigating the use of algorithms and artificial intelligence within Medicare Advantage plans. The series shed light on how UnitedHealth and its subsidiary NaviHealth utilized unregulated algorithms to predict when individuals should be cut off from rehab care. For example, employees at UnitedHealth were reportedly pressured to follow the algorithm’s predictions, even in cases where patients were not physically ready to be discharged.
The investigation underscores the potential consequences of insurers prioritizing technology-driven decisions over patient well-being. It raises concerns about the impact of these denials on the quality of care provided to seniors under Medicare Advantage plans.
In light of these findings, it is essential for policymakers, regulators, and healthcare professionals to closely monitor the use of technology in insurance coverage decisions. The balance between leveraging advanced tools for efficiency and ensuring fair and compassionate care for patients must be carefully maintained.
As the healthcare landscape continues to evolve, discussions around the ethical use of algorithms and artificial intelligence in medical settings will become increasingly important. Transparency, accountability, and patient advocacy should remain at the forefront of these conversations to safeguard the interests of vulnerable populations, such as seniors in need of rehabilitative care.
