When NaviHealth began building a business around using algorithms to scrutinize the care of older patients a decade ago, one of the country’s largest chains of inpatient rehab and long-term care hospitals was among the first to invest.
Select Medical cut a check of about $5 million — a rounding error for a conglomerate that generates more than $6 billion of revenue every year. But it was a substantial sum to put into NaviHealth, a startup that would be working directly against Select Medical’s financial interests. Health insurance companies hire NaviHealth to mine medical data and predict the post-acute care a patient will need. A STAT investigation found Medicare Advantage insurers are routinely using that unregulated technology to deny care, unbeknownst to patients and regardless of whether they need the treatment.
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