STAT+: Private Medicare plans erect barriers to rehab care in pursuit of profit, federal investigators find

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 United Health 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 United Health 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.Continue to STAT+ to read the full story…