Senators Press UnitedHealth, Humana, CVS on AI-Driven Medicare Advantage Care Denials
On July 14, 2026, Senators Richard Blumenthal and Josh Hawley sent letters to UnitedHealthcare, Humana, and CVS Health demanding documents on how each company decides post-acute care coverage, including any use of algorithms or software to determine medical necessity, payment, or authorization. What prompted them is not an AI finding: two HHS Inspector General reports issued in June put the three companies at the top of the denial tables for inpatient rehabilitation, long-term acute care, and skilled nursing admissions, and the senators want to know why. The senators asked each insurer to confirm whether it remains company policy that a final Medicare Advantage denial cannot be made by technology, and to produce an inventory of the predictive tools it uses. The insurers were given until July 28 to respond.
That date is a request, not a subpoena. Blumenthal signs as the investigations subcommittee’s ranking member, which is to say from the minority, and what makes the letters awkward to slow-walk is Hawley’s name next to his. They pull AI-assisted prior authorization out of procurement and vendor management and into congressional oversight. There the question is no longer whether the technology works but whether the decisions it informs can be defended in public: who reviewed the file, which tools were in the loop, and what happened on appeal.
What a carrier can do before it answers is inventory every AI touchpoint in prior authorization and utilization management. If an algorithm contributes to a denial, the file should show who reviewed it, what criteria were applied, and why the final decision was made. “The model recommended it” is not an answer that survives a hearing transcript, and it is the answer a thin file produces by default.
The inquiry also lands on top of active litigation rather than beside it. A federal magistrate has already ordered UnitedHealth to produce years of internal records about the nH Predict tool, including AI review board minutes and post-acute care cost-savings analyses, in a case where UnitedHealth has disputed the plaintiffs’ account and says the tool is not used to make coverage determinations. That case established the records are discoverable. July 28 tests whether they are politically retrievable as well. The specific thing to watch is the predictive-tool inventory each company returns: how complete it is, and whether it lines up with what the same three have told state regulators. Those regulators are working from the NAIC model bulletin and the state rules layered on it, which roughly half the states now have in force.