Senate report scrutinizes Medicare Advantage prior authorization denials for post-acute care services聽
A released Oct. 17 by the Senate Homeland Security Committee鈥檚 investigative subcommittee scrutinizes some of the nation's largest Medicare Advantage insurers for their use of prior authorization and high rates of denials for certain types of care. The subcommittee sought documents and information from the three largest MA insurance companies 鈥 UnitedHealthcare, Humana and CVS 鈥 and investigated their practice of 鈥渋ntentionally using prior authorization to boost profits by targeting costly yet critical stays in post-acute care facilities.鈥
The report found that between 2019 and 2022, UHC, Humana and CVS denied prior authorization requests for post-acute care at far higher rates than other types of care. In 2022, UHC and CVS denied prior authorization requests for post-acute care at approximately three times higher than the companies' overall denial rates, while Humana's prior authorization denial rate for post-acute care was more than 16 times higher than its overall denial rate. The report also found increases in post-acute care service requests subjected to prior authorization and denial rates for long-term acute care hospitals, among other findings.