A new report from the Office of Inspector General revealed 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) denial 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 rehabilitation facility denial rates were 66% for UnitedHealth Group, 54% for Humana and 51% for CVS Health, versus 41% for other MA groups.
When beneficiaries appealed denials, MA organizations overturned 36% of LTCH 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 that denied prior authorization requests on behalf of MA organizations, and many were eventually overturned on appeal. This is an independent third-party hired by a healthcare organization to handle prior authorizations.
“This raises concerns about whether contractors are receiving appropriate training and oversight from [MA organizations],” the report stated.
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 reasons for the wide variation in LTCH and inpatient rehabilitation denial and overturn rates.
CMS did not “explicitly concur or nonconcur” 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 took effect at the beginning of 2026.
One Medicare Advantage advocacy organization noted that the OIG’s data is outdated.
“This report reflects data from 2024. Since then, health plans have voluntarily eliminated roughly 6.5 million prior authorizations across markets — including more than 15 percent 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 improving prior authorization, so 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 seniors transition to high-quality, clinically appropriate care settings to support their rehab and recovery,” said Chris Bond, AHIP spokesperson.
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