Investigation into CVS Health's AI Handling of Aetna Medicare Claims

On December 17, 2025, The Schall Law Firm announced an investigation into CVS Health Corporation's handling of AI-driven prior authorization delays for Aetna Medicare Advantage plan policyholders. The scrutiny focuses on the potential misuse of artificial intelligence to deny post-acute care authorizations, possibly breaching contracts and violating state laws. This investigation highlights ongoing concerns within the insurance industry regarding the ethics and regulatory compliance of AI deployment in healthcare claims management.

This inquiry underscores the crucial need for insurers to balance technological advancements with adherence to regulatory compliance requirements and policyholder rights. It has significant implications for how payers and providers manage underwriting and claims processes, ensuring that automated systems align with ethical standards. As the insurance sector continues to integrate AI into risk management, maintaining transparency and accountability remains paramount to fostering trust and integrity across all stakeholders.