OIG Report Highlights Prior Authorization Denials, Medicaid MCOs

HomeCare August 4, 2023

A new report from the HHS Office of Inspector General (OIG) puts a spotlight on potential access issues for patients served by Medicaid Managed Care Organizations (MCOs)

WASHINGTON—A new report from the HHS Office of Inspector General (OIG) puts a spotlight on potential access issues for patients served by Medicaid Managed Care Organizations (MCOs).

The report lists three factors that may be preventing medically necessary care:

1. The high number and rates of denied prior authorization requests
2. Limited oversight of prior authorization denials in most states
3. Limited access to external medical reviews.

The OIG said it conducted this review due to allegations that some MCOs inappropriately related or denied care for thousands of people enrolled in Medicaid, including patients...

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