Lawmaker launching investigation into Medicaid prior authorization denials

U.S. Rep. Frank Pallone Jr. is launching an inquiry into prior authorization denials by Medicaid managed care organizations. 

In an Aug. 17 press release, Mr. Pallone, a New Jersey Democrat and ranking member of the House Energy and Commerce Committee, said he is "deeply troubled" by a report from HHS' Office of Inspector General that found Medicaid MCOs deny 1 in 8 prior authorization requests. 

The OIG audited seven parent companies with the highest number of enrollees, accounting for 115 MCOs across 37 states. 

"I will be contacting each of these health insurance companies directly for additional information and questions regarding their prior authorization practices," Mr. Pallone said. "It is essential that these state contracted plans are upholding their responsibility to patients and their families." 

Lawmakers have introduced a pair of bills aimed at reforming prior authorization in Medicare Advantage in recent weeks. 

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