UnitedHealth abruptly reversed restrictions on Medicare rehab care

HHealth insurance giant UnitedHealth Group is denying access to rehabilitation care required by certain groups of critically ill patients, including those living in nursing homes and those suffering from cognitive impairment, according to internal documents obtained by STAT. Used secret rules to restrict.

This document outlines parameters for clinicians initially considering referrals for rehabilitation care, and explains how many patients enrolled in Medicare Advantage plans are based on criteria unknown to clinicians and physicians. It has become clear that this led to a swift rejection.

Although UnitedHealth continued to impose restrictions through early November, administrators suddenly stopped subjecting front-line clinical reviewers to restrictions and applied more discretion, according to current employees and internal documents. He reportedly instructed him to do so. The directive to repeal the rule coincided with increased oversight of Medicare Advantage insurers by federal lawmakers and the Centers for Medicare and Medicaid Services, which will begin auditing health care denials early next year. The scrutiny comes after a series of articles in STAT exposed UnitedHealth's practices of pressuring employees to follow algorithms that cut off care for sick and elderly people already in rehab.