HealthLeaders Media May 20, 2022
CMS is urged to take steps to increase MA plan oversight and address issues raised in an OIG report.
The American Hospital Association (AHA) is asking CMS to take “swift action” against Medicare Advantage organizations (MAOs) that are inappropriately and illegally restricting access to care.
In a penned letter, AHA urges for accountability in response to a report by the Office of the Inspector General (OIG) on MAOs, which found that 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 writes. “This results in delays in care, wasteful...
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