A new report of the Office of Inspector General found that the three largest Medicare Advantage insurers denied prior authorization requests for long-term acute care and inpatient rehabilitation at high rates in 2024.
The analysis collected data from the 19 largest Medicare Advantage organizations for June 2024.
It found that long-term care hospital (LTCH) refusal rates were 80% in June 2024 for CVS Health, 72% for Humana and 71% for UnitedHealth Group, compared to 42% for all other MA organizations. Inpatient rehab facility refusal rates were 66% for UnitedHealth Group, 54% for Humana, and 51% for CVS Health, compared to 41% for other MA groups.
When beneficiaries appealed denials, MA organizations overturned 36% of long-term care denials and 43% of inpatient rehabilitation denials. This indicates that “some enrollees were initially denied medically necessary care,” according to the report.
The OIG also found that sometimes high denial rates were due to contractors denying prior authorization requests on behalf of MA organizations, and that many of these were ultimately denied on appeal. This is an independent third party hired by a healthcare organization to manage prior authorizations.
“This raises concerns about whether contractors are receiving appropriate training and supervision from [MA organizations]”, says the report.
The OIG made several recommendations to CMS, such as regularly collecting prior authorization data that includes service type and contractor information. It also recommends assessing the reasons for the wide variation in refusal and cancellation rates for long-term care and inpatient rehabilitation care.
CMS does not “explicitly agree or disagree” with these recommendations, according to the report.
The report comes after several health insurers made a series of commitments to improve prior authorization, some of which came into force at the beginning of 2026.
A Medicare Advantage advocacy organization noted that the OIG data was outdated.
“This report reflects data from 2024. Since then, health plans have voluntarily eliminated approximately 6.5 million prior authorizations across all markets, including more than 15% in Medicare Advantage,” said Mary Beth Donahue, president and CEO of Better Medicare Alliance. “Prior authorization is an important tool for safe, appropriate, and affordable care. We remain committed to working with policymakers to continue to improve prior authorization so that decisions are faster, easier, and more accurate for more than 35 million Medicare Advantage beneficiaries.”
AHIP, an organization representing payers, argued that the report omits key facts.
“The reports ignore serious, well-documented concerns about wide variations in the cost and quality of post-acute care and skilled nursing facilities. More than 35 million Americans actively choose MA because it provides them with better, more affordable care – including helping older adults transition to high-quality, clinically appropriate care facilities to support their rehabilitation and recovery,” said Chris Bond, AHIP spokesperson.
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