The American Hospital Association is urging the Justice Department to use its authority under the False Claims Act to create a fraud task force to investigate commercial insurers that routinely deny patients access to services, Healthcare Dive reports.
The hospital lobby cited what it called an “alarming” and “distressing” report from the HHS Office of the Inspector General showing that 13% of prior authorization denials and 18% of payment denials met Medicare coverage rules and should have been granted. According to the OIG report, the CMS’ annual audits of Medicare Advantage organizations have uncovered “widespread and persistent problems” involving inappropriate denials of services and payment.
“This problem has grown so large — and has lasted for so long — that only the prospect of civil and criminal penalties can adequately prevent the widespread fraud certain MAOs are perpetrating against sick and elderly patients across the country, as well as against the public,” the AHA said in a letter to Acting Assistant Attorney General Brian Boynton.
