Legislation records from the U.S. Senate

Senate Investigation Reveals Medicare Advantage Insurers Using AI to Deny Claims

Oct 17, 2024, 10:37 AM

A Senate investigation has revealed that major Medicare Advantage insurers, including UnitedHealth Group, have significantly increased the use of technology to deny claims. The report highlights that insurers utilized AI technology to deny prior authorizations for post-acute care. Internal documents obtained by STAT News show that UnitedHealth Group used $10,000 bonuses and a doctor leaderboard to encourage clinicians to diagnose more chronic illnesses in Medicare Advantage patients. Duke Health System's CEO, Craig Albanese, MD, noted that UnitedHealth denies payment for care 40% more than other national insurance carriers, with 97% of these denials being overturned after significant effort.