Senate Permanent Subcommittee on Investigations Releases Majority Staff Report Exposing Medicare Advantage Insurers'

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Senate Permanent Subcommittee on Investigations Releases Majority Staff Report Exposing Medicare Advantage Insurers' Refusal of Care for Vulnerable Seniors

With Medicare Open Enrollment underway, report unveils how Medicare Advantage insurers are intentionally using prior authorization to boost profits by denying post-acute care

[WASHINGTON, DC] – U.S. Senator Richard Blumenthal (D-CT), Chair of the U.S. Senate Permanent Subcommittee on Investigations (PSI), released a Majority staff report today detailing the Subcommittee’s findings thus far in its investigation into the barriers facing seniors enrolled in Medicare Advantage in accessing care. PSI’s Majority staff report reveals how the nation’s three largest Medicare Advantage insurers—UnitedHealthcare, Humana, and CVS—use prior authorization to target stays in skilled nursing facilities, inpatient rehabilitation facilities, and long-term acute care hospitals in order to boost their profits.

“Insurance companies say that prior authorization is meant to prevent unnecessary medical services. But the Permanent Subcommittee on Investigations has obtained new data and internal documents from the largest Medicare Advantage insurers that discredit these contentions,” said Blumenthal. “In fact, despite alarm and criticism in recent years about abuses and excesses, insurers have continued to deny care to vulnerable seniors—simply to make more money. Our Subcommittee even found evidence of insurers expanding this practice in recent years.”

On May 17, 2023, PSI launched its investigation by seeking documents and information from three insurers who together cover nearly 60 percent of all Medicare Advantage enrollees. Today’s report presents new findings based on the more than 280,000 pages of documents obtained from these three companies to date.

Through its inquiry, PSI found that between 2019 and 2022, UnitedHealthcare, Humana, and CVS each denied prior authorization requests for post-acute care at far higher rates than they did for other types of care, resulting in diminished access to post-acute care for Medicare Advantage beneficiaries. A summary of PSI’s key findings is below.
https://www.blumenthal.senate.gov/newsroom/press/release/senate-permanent-subcommittee-on-investigations-releases-majority-staff-report-exposing-medicare-advantage-insurers-refusal-of-care-for-vulnerable-seniors

Posted as an FYI, Medicare enrollment ends December 7, 2024.