Federal investigators revealed that Medicare Advantage plans denied roughly 13 percent of requests for skilled nursing facility care after hospital discharge. The probe focused on UnitedHealth Group, Humana and CVS Health, which cover about 35 million seniors. Denials hit patients needing post‑surgery or serious‑illness recovery in 2026.

Investigators noted that when seniors appeal a denial, reversal rates climb sharply. UnitedHealth alone reversed 99.7 percent of its rejections. The high overturn rate signals systemic delays that can cost hospitals and erode patient trust. Nearly one‑fifth of denied claims were contested by patients who didn't file appeals.

The reports spotlight a contractor, naviHealth, a UnitedHealth subsidiary, which posted higher denial rates for inpatient rehab. Critics allege algorithmic bias and link the firm to a pending class‑action lawsuit. Medicare’s response cites ongoing audits and a pilot to gather more prior‑authorization data, but oversight gaps remain for seniors enrolled in Medicare Advantage plans today.

Regulators urge the Centers for Medicare and Medicaid Services to tighten data collection on denial patterns and scrutinize contractor use. If unchecked, insurer cost‑saving tactics could erode the quality of post‑acute care and inflate federal spending. The findings underscore the fragile balance between managed care and essential elder health services for seniors under this program today.