The lawsuit alleges UnitedHealth used nH Predict to deny claims despite the algorithm’s determinations being overturned in more than 90% of appeals.| Healthcare Dive
More than 80% of denied requests were overturned when appealed, but few beneficiaries formally questioned the decisions.| Healthcare Dive
Only 25% of Humana members will be in plans with four stars or above next year, down from 94% this year, the insurer disclosed last week. The downgrade could wipe out Humana’s profits in 2026.| Healthcare Dive
UnitedHealth, CVS and Humana used technology to increase MA prior authorization denials for post-acute services, boosting profits, according to a report from a Senate subcommittee.| Healthcare Dive
Deputy Administrator Jon Blum signaled regulators could increasingly crack down on bad actors in the MA program, which now covers more than half of Medicare seniors.| Healthcare Dive
The payer, which brings in the bulk of its revenue from Medicare, is fighting a rule finalized earlier this year to claw back overpayments in the increasingly popular MA program.| Healthcare Dive
Sen. Ron Wyden, D-Ore., and Rep. Frank Pallone, D-N.J., sent letters requesting information on coverage denials to seven payers, including UnitedHealthcare, Aetna and Centene.| Healthcare Dive