Medicare Advantage insurers face new bipartisan scrutiny over AI and care denials

STAT News – Wednesday, July 15, 2026
By Casey Ross and Bob Herman

Sens. Richard Blumenthal (D-Conn.) and Josh Hawley (R-Mo.) are calling on the nation’s largest Medicare Advantage insurers to provide internal records and detailed information on their use of artificial intelligence to block rehabilitative care.

The lawmakers’ request — a moment of bipartisan scrutiny on a controversial federal health care program — comes just one month after a government investigation unearthed a continuing pattern of denials within Medicare Advantage.

In letters provided to STAT, Blumenthal and Hawley told executives at UnitedHealth Group, Humana, and CVS Health that recent findings by the Office of the Inspector General for the Health and Human Services Department undercut their companies’ claims to have reduced barriers to crucial medical services.

“These new HHS OIG reports suggest that little has changed,” the senators wrote. They added that, if anything, denials for post-acute care by Medicare Advantage plans “either endure or have grown worse.”

Blumenthal is the ranking Democrat on the Senate’s Permanent Subcommittee on Investigations, and Hawley also sits on the subcommittee.

A report from the panel, led by Blumenthal at the time, previously found that UnitedHealth, Humana, and CVS relied on AI and other predictive tools to deny rehabilitative care sought by older and disabled Americans at especially high rates. That subcommittee report, based on 280,000 pages of company documents requested by Blumenthal in 2023, was spurred by STAT’s investigation of Medicare Advantage plans using technology to prematurely end skilled nursing care for their enrollees.

Now, Hawley, a vocal Republican, is joining with Blumenthal to ask UnitedHealth, Humana, and CVS — the three largest Medicare Advantage insurers with a collective 60% market share — to provide records dating to January 2023 to examine how their practices have evolved.

Those records include anything tied to “the use of any algorithm, software, or artificial intelligence to determine medical necessity, payment, or authorization,” as well as records tied to how the companies handle appeals for post-acute care that is denied, according to the letters.

CVS spokesperson David Whitrap said the company received its letter and will “respond to the senators.” UnitedHealth spokesperson Eric Hausman commented broadly on the recent OIG reports, saying they “take a narrow and incomplete view of a review process that helps seniors receive timely, high-quality care, in the most appropriate setting.” He also said UnitedHealthcare “approves the vast majority of post-acute care requests” and that the company does “not use AI to deny care.” Humana did not immediately comment.

Health insurers have repeatedly trumpeted their use of AI to process claims faster, minimize delays, and curtail the use of prior authorization, which is when insurers require doctors to seek their approval before delivering certain types of care. But government investigations and independent research have found that delays and denials persist, even as funding for Medicare Advantage has ballooned. This year, Medicare Advantage is expected to cost taxpayers almost $600 billion.

The OIG reports released last month found the largest insurers used prior authorization to deny requests for rehab care at higher rates than industry peers, then frequently overturned those denials when patients appealed. The pattern suggests the insurers are deliberately erecting barriers to block access to costly services. Government data show only a fraction of Medicare Advantage beneficiaries appeal their initial rejections.

“As UnitedHealthcare and others continue to deny claims at record rates and pursue lucrative technologies that threaten patient wellbeing, it is incumbent upon Congress to provide oversight of this vast expenditure of taxpayer dollars,” Blumenthal and Hawley wrote in their letter to Tim Noel, CEO of UnitedHealthcare, the health insurance arm of UnitedHealth.

UnitedHealth, in particular, continues to invest heavily in AI. The conglomerate has committed to spend at least $3 billion on AI over the next couple of years, saying the technology will increase the speed and efficiency of America’s labyrinthian billing processes. But experts say AI also poses unknown risks to patients and the care they receive.

UnitedHealth also remains embroiled in a class action lawsuit that alleges its AI-based care denials for Medicare Advantage enrollees violated the terms of their insurance agreements. The suit focuses on coverage denials issued through a technology subsidiary formerly called NaviHealth, which was also flagged by federal investigators for blocking access to rehab care at high rates.

For the past year, plaintiffs and UnitedHealth have been going through discovery. A judge has encouraged both sides to “consider possibilities for resolving the matter.” UnitedHealth has previously said the “lawsuit has no merit.” A trial is scheduled for December 2027.

UnitedHealth, Humana, and CVS have until July 28 to respond to Blumenthal and Hawley.

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