OIG to probe whether Medicare Advantage plans deny post-acute care

HHS' Office of Inspector General will audit Medicare Advantage plans' use of prior authorization in post-acute care settings. 

In a notice issued in June, the government watchdog said it plans to audit processes for reviewing prior authorization requests in post-acute care settings, including long-term acute care hospitals, inpatient rehabilitation facilities and skilled nursing facilities. 

Previous audits have found MA plans denied some requests for post-acute care, even when beneficiaries qualified for the care under Medicare coverage rules, the OIG said. 

Some hospital leaders have alleged MA plans delay or deny members transfer to post-acute care facilities, leaving patients waiting in hospital beds. In April, the California Hospital Association sued Anthem Blue Cross of California, alleging the insurer violated the state's patient safety laws by failing to facilitate members' transfer to post-acute care. 

In December, a pair of senators urged CMS to crack down on prior authorization of post-acute stays in Medicare Advantage. 

In its notice, the OIG said it will review how often Medicare Advantage plans deny requests for post-acute stays, and where MA members are discharged to after hospitalizations. 

The OIG expects to complete its audit in 2026. 

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