The nation’s dominant Medicare Advantage insurers denied rehabilitative care for older and disabled Americans at higher rates than industry peers, then frequently overturned those denials when patients appealed, federal investigators found. The pattern reinforces longstanding concerns that insurers like UnitedHealth Group and Humana are profiting by forcing seriously ill and injured adults 65 and older to fight for care recommended by their doctors.
These health plans hired a UnitedHealth subsidiary called NaviHealth to evaluate requests for rehabilitative care. NaviHealth uses artificial intelligence to examine people’s care needs and was the focus of a STAT investigative series in 2023 that found its denials often resulted in poor outcomes for desperately ill patients.
Now, federal investigators are reporting the insurers themselves concluded NaviHealth’s denials often didn’t stand up to scrutiny. When patients appealed their blocked care, the insurers overturned the company’s denials of nursing home care 97% of the time, according to a report from the Office of Inspector General for the Health and Human Services Department.
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Read the full article at STAT News →📄Source document: Office of Inspector General for the Health and Human Services Department Report
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STAT NewsIndependentLeft10 days agoFederal investigators found that private Medicare Advantage insurers, including UnitedHealth Group and Humana, denied rehabilitative care to older and disabled Americans at higher rates than industry peers. These denials were frequently overturned when patients appealed. The insurers used a UnitedHealth subsidiary, NaviHealth, which employs AI to assess care needs. A previous STAT investigation highlighted issues with NaviHealth's denials leading to poor patient outcomes. According to the Office of Inspector General, insurers reversed NaviHealth's denials of nursing home care 97% of the time.
Bias read (Left): The article highlights systemic issues within private Medicare Advantage insurers, suggesting they prioritize profit over patient care. It emphasizes the negative impact on vulnerable populations and criticizes the use of AI in decision-making without sufficient oversight. The framing focuses on the
Official sources cited
- government Office of Inspector General for the Health and Human Services Department Report
United States