Medicare Advantage Prior Authorizations are Often Unnecessarily Denied

HealthLeaders Media May 6, 2022
Jay Asser

A report by the Office of Inspector General (OIG) raises concerns about organizations prioritizing profits over patient access to care.

Medicare Advantage organizations (MAOs) often delay or deny services for medically necessary care, even when prior authorization requests meet coverage rules, according to a report by the OIG.

A concern with the Medicare Advantage payment model is the potential incentive for organizations to deny services in an attempt to increase profits, the study states. As more and more people enroll in Medicare Advantage, the issue of inappropriate prior authorization denials can have a widespread effect.

“Denied requests that meet Medicare coverage rules may prevent or delay beneficiaries from receiving medically necessary care and can burden providers,” the report said. “Although...

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