Medscape July 27, 2023
Federal auditors have found that Medicaid managed care organizations (MCOs) denied, on average, one of every eight prior authorization requests in 2019, echoing recent concerns about similar denials for Medicare patients.
The investigation was conducted in response, in part, to allegations in the media that MCOs in several states had inappropriately denied care to thousands of Medicaid enrollees.
The audit was conducted by the Office of Inspector General (OIG) of the US Department of Health and Human Services. Investigators examined 115 MCOs that are operated in 37 states by seven parent companies: Aetna, AmeriHealth Caritas, Anthem, CareSource, Centene, Molina Healthcare, and UnitedHealthcare.
For 12 of the MCOs, denial rates were 25% or more, twice the average rate. For seven of...
Today's Sponsors
Today's Sponsor