United Healthcare is being accused of denying a growing number of claims for post-acute care as it shifted to using artificial intelligence to automate the process.
Democrats on a Senate subcommittee are accusing UnitedHealthcare Group of denying claims to a growing number of patients as it tried to leverage artificial intelligence to automate the process. In an October report, "How Medicare Advantage Insurers Have Denied Patients Access to Post-Acute Care," Democrats on the U.S. Senate Permanent Subcommittee on Investigations released a report claiming UnitedHealthcare’s prior authorization denial rate for post-acute care jumped from 10.
UnitedHealthcare tested a new "HCE Auto Authorization Model" in early 2021, and internal meeting notes revealed that it produced "faster handle times" for cases. But there was also an increase in the number of cases that were denied due to the system catching errors that were missed in the original review, according to the report. The report said the committee voted to tentatively approve the model at a meeting a month later.
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