Some Medicare Advantage Organization Denials Of Prior Authorization Requests Raise Concerns About Beneficiary Access To Medically Necessary Care

On April 27, 2022, the Office of Inspector General (OIG) at the U.S. Department of Health and Human Services (HHS) published this case file review which found that some Medicare Advantage organization denials of prior authorization requests raise concerns about beneficiary access to medically necessary care. Denying requests that meet Medicare coverage rules may prevent or delay beneficiaries from receiving medically necessary care and can burden providers.

. . .