The Office of the Inspector General of the U.S. Department of Health and Human Services is concerned that Medicare Advantage plans may be denying their members access to services to save money and increase profits.
According to the OIG, those Medicare Advantage plans overturn 75 percent of their own denials of service upon appeal and independent reviewers are overturning still more denials. In the OIG’s view, this high rate of service denials raises concerns that Medicare Advantage plans, which today serve more than 20 million seniors, are denying their members access to needed medical services so they can cut costs and make more money.
To address this problem, the OIG recommends that the Centers for Medicare & Medicaid Services increase its oversight of Medicare Advantage contracts, address problem plans it identifies, and do more to inform enrollees when their plans are performing in such a manner.
CMS agreed with these recommendations.
To learn more about how the OIG went about this work, what it found, and what it recommended, go here to see a summary of its report or go here to see the full report Medicare Advantage Appeal Outcomes and Audit Findings Raise Concerns About Service and Payment Denials Report, the complete OIG report.