Federal Watchdog Found the Three Largest Medicare Advantage Plans Denied Long-Term Hospital and Rehab Admissions at the Highest Rates

A federal oversight report published in June 2026 found that among 19 Medicare Advantage organizations reviewed, the three largest by enrollment denied prior authorization requests for care in long-term acute care hospitals and inpatient rehabilitation facilities at higher rates than most of their peers during June 2024.

The Office of Inspector General analyzed prior authorization data for these two post-acute care settings. When enrollees appealed denials, Medicare Advantage organizations collectively overturned 36 percent of long-term acute care hospital denials and 43 percent of inpatient rehabilitation facility denials. Variation across organizations was wide: inpatient rehabilitation overturn rates ranged from 14 percent to 86 percent depending on the plan.

The report also found that high denial rates were in some cases driven by contractors that plans had hired to review requests on their behalf. Many denials issued by those contractors were later reversed by the plan itself on appeal, which the OIG flagged as a concern about whether contractor decisions were adequately supervised.

The OIG recommended that CMS collect request-level prior authorization data that includes service type and contractor information, and that CMS assess the wide variation in denial and overturn rates and take appropriate action. CMS neither agreed nor disagreed with the recommendations at the time of publication.

Long-term acute care hospitals and inpatient rehabilitation facilities serve Medicare patients recovering from serious illness or injury, including strokes, major surgeries, and traumatic injuries.