Doctors everyday recommend thousands of seniors who’ve had a fall, a stroke, or an acute illness to continue to recover at home or at a skilled nursing facility. But insurers deploy AI to deny these post-acute care recommendations to drive up profits, according to a U.S. Senate subcommittee tasked last May with uncovering barriers to post-acute care for seniors enrolled in Medicare Advantage.
The findings, documented in a new report, are based on more than 280,000 pages of documents obtained from UnitedHealthcare, Humana, and CVS — the largest insurers offering Medicare Advantage plans.
All three denied prior authorization requests between 2019 and 2022 for post-acute care at far higher rates than they did for other types of care, leading to the lack of treatment for people enrolled in Medicare Advantage plans, the report claims.
Insurers have continued “to deny care to vulnerable seniors — simply to make more money,” U.S. Sen. Richard Blumenthal, a Connecticut Democrat and subcommittee chairman, said in a statement. “Our subcommittee even found evidence of insurers expanding this practice in recent years.”
The subcommittee recommends that the Centers for Medicare & Medicaid Services should develop systems to prevent AI from negatively influencing human reviewers.
