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Senate report links insurer automation to rising Medicare Advantage post-acute denials

See how this story connects

Source: US Senate PSI majority staff report: Refusal of Recovery

The US Senate Permanent Subcommittee on Investigations majority staff report of 17 October 2024 found that UnitedHealthcare, Humana and CVS denied prior authorisation for post-acute care far more often than for other care in 2019-2022. UnitedHealthcare’s post-acute denial rate rose from 10.9% in 2020 to 22.7% in 2022 while it was automating parts of the review process, and the report also examined naviHealth, maker of the nH Predict algorithm. The report asked CMS to stop predictive tools from unduly influencing human reviewers.

Why it matters

Medicare Advantage insurers faced documented congressional findings tying automated and predictive review to higher denials, with a recommendation that CMS tighten rules on such tools.

When
17 Oct 2024
ID
WTA-N-2024-0014
Who
US Senate Permanent Subcommittee on Investigations, UnitedHealthcare, Humana, CVS Health, naviHealth, CMS

Summary by wheresthe.ai, from US Senate PSI majority staff report. Checked against the source on 9 Oct 2026.

Read the original at US Senate PSI majority staff report

Source copy: download the source PDF as saved on 18 Oct 2026 (PDF). Document the source offers: the source PDF. Also held by the Internet Archive.

Next stop on this Storyline: What happened nextSenate declines to take up repeal of Medicare’s AI prior-authorisation pilot

Cite this story

WTA-N-2024-0014: “Senate report links insurer automation to rising Medicare Advantage post-acute denials.” wheresthe.ai, 17 Oct 2024. https://wheresthe.ai/d/us-senate-psi-medicare-advantage-denials-2024-10/ (source: US Senate PSI majority staff report: Refusal of Recovery).

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