Overview
- The HHS Office of Inspector General reports released June 11, 2026 found unusually high initial denial rates for post-hospital rehab and long-term care among 19 large Medicare Advantage parent companies covering about 29.3 million enrollees.
- Across the sample, plans denied roughly 65% of long-term acute care hospital requests and 54% of inpatient rehabilitation requests in June 2024, with CVS Health, Humana and UnitedHealth among the highest deniers.
- When patients or providers appealed denials, insurers overturned a large share of decisions—36% for long-term acute care, 43% for inpatient rehab, and 95% for skilled nursing facility denials—raising concerns about delays to medically recommended care.
- Investigators flagged outside contractors, notably naviHealth, as driving many denials and recommended CMS collect request-level data and examine contractor oversight; the OIG also plans in-depth case-file reviews to identify root causes.
- Insurers and trade groups pushed back, citing voluntary cuts to prior-authorization requirements since 2024, while patient advocates warn denials can force lower-intensity care, out-of-pocket bills, and added burdens on families.