Audit Highlights Medicaid MCOs’ High Rates of Prior Authorization Denials

Healthcare Innovation July 28, 2023
David Raths

Office of Inspector General at HHS found that among the 115 managed care organizations in its review, 12 had prior authorization denial rates greater than 25 percent

A federal audit of Medicaid managed care organizations (MCOs) found thatone out of every eight requests for the prior authorization of services in 2019 was denied, and that most state Medicaid agencies did not routinely review the appropriateness of a sample of MCO denials.

The July 2023 report from the Office of Inspector General at the U.S. Department of Health & Human Services noted that among the 115 MCOs in its review, 12 had prior authorization denial rates greater than 25 percent — twice the overall rate. The absence of robust mechanisms for...

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