Detailed summary of important points (from the Medicare Rights Center article by Julie Carter, published June 25, 2026):

The article discusses a new report from the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) on Medicare Advantage (MA) prior authorization practices for post-acute care. It builds on a prior OIG report about skilled nursing facility (SNF) denials.

Key OIG Findings:

  1. OIG analyzed data from the 19 largest MA organizations. Average denial rates were 65% for Long-Term Care Hospital (LTCH) requests and 54% for Inpatient Rehabilitation Facility (IRF) requests.
  2. The three largest MA organizations (UnitedHealth, Humana, and CVS/Aetna), covering over 20 million people, had disproportionately higher denial rates than peers:
  3. LTCH denials: CVS 80%, Humana 72%, UnitedHealth 71% (vs. as low as 8% for UPMC).
  4. IRF denials: UnitedHealth 66%, Humana 54%, CVS 51% (vs. as low as 4% for Healthfirst).
  5. Denial rates were higher among for-profit plans than not-for-profit ones. Use of outside contractors was linked to both higher denials and higher appeal overturn rates.

Appeals and Impacts:

  1. Many denials were overturned on appeal (36% for LTCH, 43% for IRF), suggesting some initial denials may have been inappropriate.
  2. Appeals cause delays (median 5–6 days; up to 10+ days for some), leading to patients going without care, paying out-of-pocket, or staying in higher-cost settings.

Context and Recommendations:

The article explains that MA plans receive fixed payments per enrollee and can profit by spending less, creating incentives for restrictive prior authorization. It calls for major reforms to prior authorization to prevent denial or delay of medically necessary care.

  1. Full article link: https://www.medicarerights.org/medicare-watch/2026/06/25/largest-ma-organizations-have-disproportionate-denial-rates-for-some-post-acute-care OIG report: https://oig.hhs.gov/documents/audit/11693/OEI-09-24-00330.pdf