Skilled care operators have long been accused — often unfairly — of prioritizing profits over resident care.

But if a new Senate report is to be believed, even the greediest nursing facilities might seem saintly compared to the shenanigans coming from the nation’s largest Medicare Advantage companies.

The majority staff’s 54-page report, released last week, doesn’t mince words. Investigators specifically call out UnitedHealthcare, Humana and CVS for denying critical post-acute care services to boost their bottom lines.

The details are alarming: UnitedHealthcare’s denials of skilled nursing facility admissions skyrocketed ninefold between 2019 and 2022. The culprit? AI-powered tools designed to reject more claims. And unfortunately, other MA firms are following suit.

These same insurers proudly market themselves to the public and the government as offering better, more affordable coverage than traditional Medicare. But is that really the case? The evidence here paints a much darker picture.

By denying access to necessary post-acute care, they are forcing seniors and their families into impossible situations: either remain in a facility and shoulder crushing out-of-pocket costs or return home prematurely, where they may lack the support needed for a full recovery. It’s a lose-lose scenario for those most in need of care.

In light of its findings, the report calls on CMS to take several actions, including:

  • Collecting prior authorization data broken down by service category
  • Conducting targeted audits if insurer prior authorization data reveals significant increases in adverse determinations
  • Expanding regulations on insurers’ utilization management committees to ensure predictive technologies don’t unduly influence human reviewers.

But will any of these recommendations be implemented, and if so, when?

Nursing homes have been warning for years about the dangers of pushing patients into home care before they’re ready. With more than half of Medicare beneficiaries now enrolled in MA plans, this troubling trend isn’t going away — it’s accelerating. And as these insurers tighten their grip on post-acute care, we can expect them to get even more aggressive.

For operators, this report should sound the alarm. The insurers promising better coverage and cost control are the same ones making decisions that undercut both patient care and provider viability.

So, who’s really putting profits before patients now? The Senate report makes that clear.

 John O’Connor is editorial director for McKnight’s.

Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.