Private Medicare Advantage plans have wrongly denied members needed care that otherwise would have been covered under the traditional Medicare program, according to a report released Thursday from federal investigators responsible for oversight of the HHS, Healthcare Dive reports.
After reviewing a sample of denials, investigators found that 13% of prior authorization requests and 18% of payment denials were wrongly denied and should have been approved under Medicare coverage rules.
The report from the inspector general’s office of HHS calls for improved oversight of MA and urges the CMS to update audit protocols and issue new guidance on medical necessity reviews performed by the plans. Read more.
