The Schall Law Firm, a national litigation firm based in Los Angeles, is investigating claims on behalf of Aetna Medicare Advantage policyholders. The investigation targets CVS Health Corporation for alleged breach of contract and violations of state laws. At the center of this case is a troubling allegation: CVS may have used artificial intelligence to improperly deny post-acute care claims — without proper review by a medical professional.
If you hold or previously held an Aetna Medicare Advantage plan and CVS denied your post-acute care authorization request, you may have the right to join this investigation.
What the Investigation Is About
Breach of Contract and Improper Denials
The Schall Law Firm is examining whether CVS/Aetna wrongfully denied prior authorization requests for post-acute care. Post-acute care refers to medical services a patient needs after a hospital stay. This includes skilled nursing facilities, rehabilitation centers, and home health services.
Under the terms of their contracts with policyholders, CVS is required to have qualified medical professionals review and approve or deny prior authorization requests. However, the investigation centers on whether CVS instead used an AI-based program to screen and deny these claims before any licensed medical professional ever reviewed them.
How CVS Used AI to Deny Claims
AI Screening Raised Serious Red Flags
CVS’s use of artificial intelligence to handle prior authorizations recently drew attention from the U.S. Senate. Lawmakers raised concerns about whether this practice violates the rights of Medicare Advantage beneficiaries.
The concern is clear and specific. When AI makes the call — rather than a trained clinician — patients recovering from serious illnesses or surgeries may face sudden and unjustified coverage denials. Furthermore, these denials can interrupt critical recovery care. They can also leave patients with unexpected out-of-pocket costs that they were not prepared to handle.
The investigation covers the period from November 2019 through the present. During this time, CVS may have systematically used AI to process and deny post-acute care authorizations in a manner that conflicts directly with its own contractual obligations.
Who Qualifies to Join the Investigation
Eligibility Criteria for Affected Policyholders
You may be eligible to participate in this investigation if you meet the following criteria:
- You are or were an Aetna Medicare Advantage plan policyholder
- Your prior authorization request for post-acute care was denied
- The denial occurred between November 2019 and the present
Participation is open to current and former policyholders alike. Additionally, the Schall Law Firm offers a free consultation to help you understand your legal rights and options.
Why This Investigation Matters
Protecting Seniors From Unjust Coverage Denials
This investigation carries significant weight for Medicare beneficiaries across the country. Medicare Advantage plans are a popular alternative to traditional Medicare. Millions of seniors depend on these plans for reliable, affordable coverage — especially after hospitalizations.
When insurers use automated tools to bypass human medical review, patients can lose access to the care they need most. Post-acute care is not optional for many seniors. It is essential for safe and complete recovery. Denying it without proper clinical review is not only a potential contract violation — it may also cause direct and lasting harm to vulnerable patients.
Moreover, the U.S. Senate’s scrutiny of this practice signals growing regulatory and legislative concern. Investigations like this one serve as a critical check on the expanding use of AI in healthcare decisions, where patient outcomes are at stake.
How to Contact the Schall Law Firm
Take Action Before It Is Too Late
The Schall Law Firm invites affected policyholders to reach out and explore their legal options at no cost. Contact details are as follows:
Brian Schall, Esq. The Schall Law Firm 2049 Century Park East, Suite 2460 Los Angeles, CA 90067 Phone: 310-301-3335 Email: bschall@schallfirm.com Website: www.schallfirm.com
Affected policyholders can also submit their information directly through the firm’s website to join the investigation. Taking action early ensures your claim is properly documented and considered.
