CVS Health Under Investigation for Denying Medicare Advantage Claims
The Schall Law Firm has launched an investigation into claims against CVS Health Corporation and its subsidiary Aetna regarding potential breaches of contract related to Medicare Advantage plans. The inquiry, announced on November 21, 2025, centers on allegations that CVS/Aetna improperly denied prior authorizations for post-acute care, which follows hospital stays. This denial process reportedly involved an artificial intelligence system.
The investigation seeks to determine whether CVS/Aetna’s practices constitute violations of state laws regarding healthcare provisions. Specifically, the focus is on how the artificial intelligence program may have influenced decision-making in authorizing necessary medical treatments for policyholders.
The Schall Law Firm, a national litigation firm based in Los Angeles, is encouraging affected policyholders to come forward. According to their statement, the firm is examining the methods used by CVS/Aetna to assess prior authorization requests. If it is found that the artificial intelligence system led to unjustified denials, the firm may pursue legal action on behalf of those affected.
Aetna, part of the CVS Health portfolio, provides Medicare Advantage plans that serve millions of seniors across the United States. These plans are designed to offer additional benefits beyond traditional Medicare, including coverage for post-acute care, which is essential for recovery following hospitalization.
The ongoing investigation highlights the increasing reliance on technology, specifically artificial intelligence, in healthcare decision-making. While such tools can enhance efficiency, concerns have arisen regarding their potential to compromise patient care and access to necessary services.
Policyholders who believe they have been impacted by these practices are encouraged to seek information from the Schall Law Firm. The firm aims to provide clarity and support for those navigating the complexities of their healthcare plans, particularly in light of this potential breach of contract.
As the investigation progresses, further updates are expected, shedding light on the implications for CVS Health and Aetna, as well as the broader healthcare landscape that increasingly integrates technology into patient care processes.
