Lawmakers are scrutinizing managed care

Becker's Healthcare October 10, 2023
Rylee Wilson

Federal lawmakers have been probing payers on a variety of issues in recent months, raising concerns on prior authorizations, Medicare Advantage costs, artificial intelligence and more.

Here are some of the issues lawmakers have taken up with managed care providers in recent months:

Medicaid prior authorization denials

A report on Medicaid prior authorization denials has some lawmakers concerned. An HHS Office of Inspector General report, published in July, found the seven largest Medicaid MCO parent companies deny around 1 in 8 prior authorization requests. Of the 115 MCOs the OIG audited, 12 had prior authorization denial rates greater than 25 percent.

On Sept. 28, Sen. Ron Wyden, chair of the Senate Committee on Finance, and Rep....

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