Senate Permanent Subcommittee on Investigations Releases Majority Staff Report Exposing Medicare Advantage Insurers'
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.
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Despite the enormous growth in enrollment, some two dozen health systems have announced over the past
year that they will stop accepting Medicare Advantage beneficiaries, with hospitals and providers
overwhelmingly citing frustration with prior authorization. Prior authorization was one of the tools given
to insurers participating in the program to help them prevent harmful or unnecessary medical services, but
as HHS OIG and others have warned, the structure of Medicare Advantage can incentivize companies to
use the process to deny care to which patients are entitled. The evidence in this report demonstrates that
this is likely occurring at a scale impacting tens of thousands of elderly Americans, and that denials are
overwhelmingly occurring in costly but critical post-acute care.
Regulators collect certain information about Medicare Advantage insurers’ use of prior authorization, but
the opacity of the current system is part of what enables insurers to abuse it. The Subcommittee was able
to analyze prior authorization data that Medicare Advantage insurers are not currently required to make
public, and to examine internal documents from the insurers that provide context for the trends born out
in this data. But many of the issues that most frustrate patients and providers remain cloaked in
uncertainty. This is particularly true of insurers’ use of automation and predictive technologies, which PSI
continues to investigate. Media reporting on this issue indicates that many of the most disturbing
practices, including using artificial intelligence to fix Medicare Advantage beneficiaries’ lengths of stay in
certain facilities, were accomplished through informal pressure campaigns on employees. Such wrongs
are unlikely to be captured in computer code or official communication, to say nothing of regulatory
filings.
Although the Subcommittee’s recommendations in this report are targeted at regulators, this should not
distract from the fact that it is insurers who are using prior authorization to protect billions in profits while
forcing vulnerable patients into impossible choices. This is particularly troubling when recent analyses
indicate that Medicare Advantage is more expensive than Traditional Medicare, with one assessment
concluding that, in 2024, the government spent 22 percent more to fund Medicare Advantage plans than
it would have had those beneficiaries been enrolled in Traditional Medicare.257 There is a role for the free
market to improve the delivery of healthcare to America’s seniors, but there is nothing inevitable about the
harms done by the current arrangement. Insurers can and must do better, for the sake of the American
healthcare system and the patients the government entrusts to them.
seriously
I do understand why people go on MA, especially people of modest means. And I agree with you that privatizing NEVER, EVER saves money......the entire point of privatization is increased profits for assholes.
Wishing you a Happy Thanksgiving 