STAT+: Private Medicare plans erect barriers to rehab care in pursuit of profit, federal investigators find

STAT PlusExclusive Private Medicare plans erect barriers to rehab care in pursuit of profit, federal investigators find UnitedHealth Group’s NaviHealth had high denial rates for post-acute care By Casey Ross and Bob HermanJune 11, 2026 Ross and Herman have been investigating denials of rehabilitative care by large health insurers for three years. They previously published an investigation into insurers’ reliance on NaviHealth to scrutinize these requests, which was a finalist for a Pulitzer Prize. Casey Ross[email protected]Casey’s reporting examines the use of artificial intelligence by providers and insurers.Bob Herman[email protected]Bob covers the money in health care, focusing on health insurance and hospitals. His stories delve into Medicare Advantage, opaque prescription drug benefits, and how much executives actually make. He is also the author of the Health Care Inc. newsletter. You can reach Bob on Signal at bobjherman.09. Manage alerts for this article Email this article Share this article The nation’s dominant Medicare Advantage insurers denied rehabilitative care for older and disabled Americans at higher rates than industry peers, then frequently overturned those denials when patients appealed, federal investigators found. The pattern reinforces longstanding concerns that insurers like UnitedHealth Group and Humana are profiting by forcing seriously ill and injured adults 65 and older to fight for care recommended by their doctors. These health plans hired a UnitedHealth subsidiary called NaviHealth to evaluate requests for rehabilitative care. NaviHealth uses artificial intelligence to examine people’s care needs and was the focus of a STAT investigative series in 2023 that found its denials often resulted in poor outcomes for desperately ill patients.Advertisement Now, federal investigators are reporting the insurers themselves concluded NaviHealth’s denials often didn’t stand up to scrutiny. When patients appealed their blocked care, the insurers overturned the company’s denials of nursing home care 97% of the time, according to a report from the Office of Inspector General for the Health and Human Services Department. STAT+ Exclusive Story Already have an account? Log in This article is exclusive to STAT+ subscribers Unlock this article — plus in-depth analysis, newsletters, premium events, and news alerts. Already have an account? Log in Monthly $39 Totals $468 per year $39/month Get Started Totals $468 per year Starter $30 for 3 months, then $399/year $30 for 3 months Get Started Then $399/year Annual $399 Save 15% $399/year Get Started Save 15% 11+ Users Custom Savings start at 25%! Request A Quote Request A Quote Savings start at 25%! 2-10 Users $300 Annually per user $300/year Get Started $300 Annually per user View All Plans To read the rest of this story subscribe to STAT+. Subscribe Log In aging, CMS, Health insurance, medicare advantage, patients, Policy, public health, STAT+ Submit a correction requestReprints Casey Ross Chief Investigative Reporter, Data & Technology Casey’s reporting examines the use of artificial intelligence by providers and insurers. Bob Herman Business of Health Care Reporter Bob covers the money in health care, focusing on health insurance and hospitals. His stories delve into Medicare Advantage, opaque prescription drug benefits, and how much executives actually make. He is also the author of the Health Care Inc. newsletter. You can reach Bob on Signal at bobjherman.09. Recommended The Readout June 10, 2026 STAT Plus: Hope for Kendall Square’s lab market D.C. Diagnosis June 9, 2026 STAT Plus: Trump’s health care affordability czar takes aim at hospitals Advertisement The Readout June 9, 2026 Gilead and Merck’s latest trial success and flop Politics June 9, 2026 STAT Plus: Trump’s health care affordability czar touts Medicaid cuts to hospital leaders Health Care Inc. Newsletter June 8, 2026 STAT Plus: UnitedHealthcare’s lactation billing feud, and fake strokes Subscriber Picks