FAH President and CEO Chip Kahn released the following statement after UnitedHealthcare released an unlawful inpatient coverage policy for Medicare Advantage (MA) plans: 

“FAH believes CMS actions taken earlier this year to protect seniors from abusive behavior by Medicare Advantage plans are mission critical.  Most importantly, to preserve the promise of Medicare to MA beneficiaries, CMS specifically prohibits MA plans from limiting or denying coverage for items or services assured to them under Medicare law and provided to those who remain in traditional Medicare. However, CMS actions only work if MA plans follow the law and if CMS enforces it by promptly addressing plan violations.  

“The test case to ensure all Medicare beneficiaries get the coverage they are entitled to are the MA plans provided by UnitedHealthcare. As the largest MA provider in the country, UnitedHealthcare recently released a new coverage policy for hospital services effective January 1, 2024, that blatantly violates Medicare’s revised coverage criteria for inpatient hospital care. Among other concerns, UnitedHealthcare continues to use proprietary software that unlawfully narrows MA beneficiaries’ inpatient hospital benefits, creating patient care risks as well as higher cost-share burdens.   

“Medicare beneficiaries should not be shortchanged by UnitedHealthcare or any MA plan. We have flagged UnitedHealthcare’s unlawful policies for CMS and pledge to work with the Agency to ensure Medicare’s coverage policies for all of America’s seniors.”