Medicare Advantage organizations have limited beneficiaries’ access to necessary care. They have also denied payments to providers for services that are covered under Medicare rules, as well as MA billing rules.
That’s according to a report released by the Office of Inspector General. The report examined data over the course of one week in June 2019 from the 15 of the largest MA organizations. This includes Humana, CVS Health, UnitedHealth Group, Anthem, Kaiser Permanente and SCAN Health Plan.
Specifically, OIG found that roughly 13% of prior authorization requests denied by MA plans met the criteria for Medicare coverage rules. Read more.
