April 28, 2022
  • The U.S. Health and Human Services Department Office of the Inspector General (OIG) released a report indicating that Medicare Advantage plans improperly deny millions of reimbursement claims and authorization requests for medically necessary care. The OIG found “widespread and persistent problems” with the program – for example, 13 percent of prior authorization denials were for service requests that met Medicare coverage rules – and recommended that Medicare officials ramp up oversight and enforcement on these private plans. (Report here; Article here)