Medicare Advantage Investigation by OIG | Denials For Profit

The Office of Inspector General for the Department of Health and Human Services (OIG) has concluded its investigation into denials of care with Medicare Advantage Organizations (MAO's) and the findings are quite disturbing. Routine denials of care are happening at an alarming rate and the OIG finds that profit is the motive. When the member of the Medicare Advantage plan has appealed the denials they were overturned in up to 75% of the cases. Members who do not appeal are denied any payment for services that were not approved.

See the OIG study on Medicare Advantage here:

See the letter to CMS from 100 members of Congress:

See the study on Pre-Authorizations on Medicare Advantage:

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OIG study on Medicare Advantage
Pre-Authorizations on Medicare Advantage
Medicare Advantage Appeals Process

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