The Department of Health and Human Services Office of Inspector General (OIG) issued a report titled “Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care” (April 2022, OEI-09-18-00260). As reported in a New York Times article titled “Medicare Advantage Plans Often Deny Needed Care, Federal Report Finds” by Reed Abelson (April 28, 2022), “[t]ens of millions of denials are issued each year for both authorization and reimbursements, and audits of the private insurers show evidence of ‘widespread and persistent problems related to inappropriate denials of services and payment,’ the investigators found.” The findings are similar to 2018 report issued by OIG titled “Medicare Advantage Appeal Outcomes and Audit Findings Raise Concerns About Service and Payment Denials”.
The Center for Medicare Advocacy is reviewing the report, and will provide additional analysis in next week’s CMA Alert.