American Hospital Association May 19, 2022
The AHA today urged the Centers for Medicare & Medicaid Services to “take swift action to hold Medicare Advantage plans accountable for inappropriately and illegally restricting beneficiary access to medically necessary care,” citing in part a recent report from the Department of Health and Human Services’ Office of Inspector General that found an estimated 13% of prior authorization denials and 18% of payment denials should have been granted.
“Inappropriate and excessive denials for prior authorization and coverage of medically necessary services is a pervasive problem among certain plans in the MA program,” AHA wrote. “This results in delays in care, wasteful and potentially dangerous utilization of fail-first imaging and therapies, and other direct patient harms. In addition, they add financial...
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