Health Cos. Can challenge delays from the Medicare Advantage organization

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

The April report, “Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care,” outlines OIG findings that MAOs used the prior authorization process to deny or delay approval of services for Medicare Advantage beneficiaries even if the services met Medicare coverage standards.

The OIG also found that MAOs had refused and delayed payments to providers,…

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