Health Cos. Can Challenge Medicare Advantage Org Delays

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By Maureen Weaver and Megan George (June 10, 2022, 5:53 PM EDT) — A recent U.S. Department of Health and Human Services Office of Inspector General report has sparked a call to motion to curb questionable tactics that Medicare Advantage organizations, or MAOs, deploy under the guise of managing care.[1]

The April report, “Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Crucial Care,” describes the OIG’s findings that MAOs have used the prior authorization process to disclaim or delay approvals of services to Medicare Advantage beneficiaries though the services met Medicare coverage standards.

The OIG also found that MAOs have denied and delayed payments to providers,…

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