Senators: CMS Needs To Hold MA Plans Accountable For AI-Driven Prior Auth Denials

CMS should require Medicare Advantage (MA) insurers to provide detailed prior authorization data by service type, audit insurers with unusually high denial rates, and ensure artificial intelligence (AI) and predictive technologies don’t overly influence human reviewers' medical decisions, according to a new report from the Senate Permanent Subcommittee on Investigations, which suggests MA insurers are deliberately using prior authorization to boost profits by targeting costly yet essential post-acute care services.