Richard Blumenthal

10/09/2025 | Press release | Distributed by Public on 10/10/2025 09:58

BLUMENTHAL RAISES CONCERNS ABOUT MEDICARE ADVANTAGE INSURERS’ ABUSE OF AI

  1. Newsroom
  2. Press Releases
Published: 10.09.2025

BLUMENTHAL RAISES CONCERNS ABOUT MEDICARE ADVANTAGE INSURERS' ABUSE OF AI

In a follow-up to year-long PSI inquiry, Blumenthal seeks answers from UnitedHealthcare, CVS, and Humana about use of predictive technologies to deny patients care

[WASHINGTON, DC] - U.S. Senator Richard Blumenthal (D-CT), Ranking Member of the Permanent Subcommittee on Investigations (PSI), today raised concerns about Medicare Advantage insurers' use of artificial intelligence to make health care decisions that may result in vulnerable seniors being denied critical care. In letters to UnitedHealthcare, CVS, and Humana, Blumenthal requested information about the insurers' use of AI and any policies in place to prevent predictive technologies from unduly influencing the work of human clinicians.

As the top Democrat on PSI, Blumenthal led a year-long investigation into delays and denials of care in the Medicare Advantage program. Among its findings, PSI revealed that during the same period in which UnitedHealthcare and other insurers were making significant investments in predictive technologies, prior authorization denial rates for vulnerable seniors increased. As AI continues to rapidly develop without adequate guardrails, Blumenthal is following up the Subcommittee's previous findings to assess how Medicare Advantage insurers are using AI and other predictive technologies.

In a letter to UnitedHealthcare CEO Tim Noel, Blumenthal raised concerns about the possibility for abuse of AI tools in the health care sector, "A recent survey from the American Medical Association found that 61 percent of physicians fear that insurers' growing use of predictive technologies 'is increasing prior authorization denials.' And beginning next year, the Trump Administration plans to launch a new AI-powered initiative to bring prior authorization to Traditional Medicare-where it has historically been absent-and has invited insurers like UnitedHealthcare to participate in the program."

"But despite the Subcommittee's recommendation that insurers be required to report more data about the denials they issue and the role that AI plays in coverage determinations, regulators and the public remain woefully lacking in critical information needed to detect and curb harms resulting from misuses of the prior authorization process. As a result, the American people continue to be reliant little more than insurers' promises that they are not taking potential life-and-death decisions away from doctors and giving them to machines," Blumenthal concluded.

PSI's October 2024 majority staff report on Medicare Advantage insurers' use of prior authorization to boost post-acute care can be found here. The full text of Blumenthal's letter to UnitedHealthcare is available here and below. Similar letters were sent to CVS and Humana.

Dear Mr. Noel:

Last October, the Permanent Subcommittee on Investigations ("the Subcommittee") released a majority staff report on delays and denials of care in the Medicare Advantage program.[1] The report followed revelations that large Medicare Advantage insurers were using predictive technologies, including Artificial Intelligence ("AI"), to limit or deny the care of vulnerable seniors.[2] Throughout the Subcommittee's investigation, each of the companies investigated, including UnitedHealthcare, consistently denied that they used AI to make final decisions regarding patient care.[3] Given the proliferation of AI technology and continued reports of disproportionate denials in Medicare Advantage, I write to ask whether that remains your company's policy.

The Subcommittee's report was based on more than a year of investigation and review of more than 280,000 pages of documents obtained from the three largest Medicare Advantage insurers, including company emails, internal strategy documents, and data not provided to regulators. For the first time, the Subcommittee was able to document how, during the same period in which UnitedHealthcare and other insurers were making significant investments in predictive technologies, prior authorization denial rates for admission to certain post-acute care facilities increased. Although insurers denied that these technologies had final authority over the denials driving the increases, the report documented ways in which workers responsible for prior authorization may have been pressured to follow machine-generated recommendations, or that contractors may have had greater latitude to use AI in making care determinations.[4]

Since the release of the Subcommittee's report, the rapid development of AI has only increased the possibility of its abuse in the healthcare sector. The Subcommittee's report was based on data through the year 2022, but according to the American Hospital Association, Medicare Advantage denials have increased significantly since then, and "[o]ne factor driving this growth is the increased use of machine learning algorithms and other artificial intelligence tools."[5] A recent survey from the American Medical Association found that 61 percent of physicians fear that insurers' growing use of predictive technologies "is increasing prior authorization denials."[6] And, beginning next year, the Trump Administration plans to launch a new AI-powered initiative to bring prior authorization to Traditional Medicare-where it has historically been absent-and has invited insurers like UnitedHealthcare to participate in the program.[7]

Amid the largely unregulated expansion of AI, the Center for Medicare and Medicaid Services ("CMS") has confirmed that giving predictive technologies the authority to deny care is against the law.[8] But despite the Subcommittee's recommendation that insurers be required to report more data about the denials they issue and the role that AI plays in coverage determinations, regulators and the public remain woefully lacking in critical information needed to detect and curb harms resulting from misuses of the prior authorization process.[9] As a result, the American people continue to be reliant on little more than insurers' promises that they are not taking potential life-and-death decisions away from doctors and giving them to machines.

In order to help the Subcommittee assess how Medicare Advantage insurers are using AI or other predictive technology to make health care decisions, please respond to the following questions by October 17, 2025:

  1. Does it remain the policy of UnitedHealthcare that final adverse determinations for Medicare Advantage beneficiaries cannot be made by AI or other predictive technologies?
    1. If not, please provide a detailed description of when this change was implemented, as well as all records reflecting the change in policy;
  2. Which AI or predictive technologies have been employed by UnitedHealthcare for the evaluation of patient care or the payment for patient services? Please include the name of the technology, how it is used, and any limitations on its use; and
  3. Please describe any policies implemented since October 2024 to prevent predictive technologies from unduly influencing the work of human clinicians.

Thank you for your attention to this matter.

Sincerely,

-30-

  • Print
  • Email
  • Share
  • Tweet
Previous Article
Next Article
Richard Blumenthal published this content on October 09, 2025, and is solely responsible for the information contained herein. Distributed via Public Technologies (PUBT), unedited and unaltered, on October 10, 2025 at 16:03 UTC. If you believe the information included in the content is inaccurate or outdated and requires editing or removal, please contact us at [email protected]