Report Finds MA Insurers Intentionally Denied Prior Authorizations for Post-Acute Care (SNF)

On October 17, the U.S. Senate Permanent Subcommittee on Investigations (PSI) released a Majority Staff Report that found the three largest Medicare Advantage (MA) insurers denied prior authorizations for post-acute care at much higher rates than other types of care. The impact is that hundreds of thousands of beneficiaries who needed medically appropriate post-acute care were denied access to care during the prior authorization process. The denials came, in large part, from advanced technology systems that used artificial intelligence to flag costly coverage requests and minimize the approved coverage or, ultimately, deny the claim altogether.

The PSI report looked at the three largest Medicare Advantage insurers, UnitedHealthcare, Humana and CVS, and found that denial rates for post-acute care at each insurer increased dramatically and disproportionately between 2019 and 2022. Going forward, PSI made recommendations in the report regarding oversight and regulatory interventions in an effort to ensure medical claims are properly reviewed and that any notable increases in denials are properly audited. Read the AHCA/NCAL statement on the issue here.