Washington E-Newsletter

HHS OIG Update on Medicare Advantage Plan Prior Authorization

  • Reimbursement and Practice Management

On March 18, the U.S. Department of Health and Human Services Office of the Inspector General (OIG) published an “impact brief” highlighting the OIG’s work on Medicare Advantage (MA) plan prior authorization issues. The report notes that MA organizations deny over one million prior authorization requests yearly. In 2019, an estimated 13% were for services the OIG deemed medically necessary for the patient. The document outlines specific concerns and steps undertaken to address the problems