The Senate Permanent Subcommittee on Investigations released a report today that majority staff says shows how Medicare Advantage insurers purposely deny prior authorization requests for post-acute care, Victoria reports.
Why it matters: The report continues a pattern in which Democratic lawmakers are scrutinizing the Medicare Advantage program and insurers' prior authorization methods, including how they use artificial intelligence.
What's inside: Documents were requested from three top Medicare Advantage insurers: UnitedHealthcare, Humana and CVS.
- The committee said that according to documents it obtained, UnitedHealthcare's prior authorization denial rates increased annually as the insurer was implementing automated processes.
- CVS was also alleged to have used AI to reduce the amount spent on skilled nursing facilities.
- And the committee said Humana had given presentations that had information on how requests from providers for long-term acute care hospitals should be evaluated, including how to explain denials.
What they're saying: "Despite alarm and criticism in recent years about abuses and excesses, insurers have continued to deny care to vulnerable seniors — simply to make more money," said Investigations Chair Richard Blumenthal, in a statement.
- CVS Health said the report significantly misrepresents its use of prior authorization and that many of the documents cited are outdated, while others are drafts or were used for internal deliberations.
