“OIG: MA plans denying, delaying services to beneficiaries”

“OIG: MA plans denying, delaying services to beneficiaries,” by Diane Eastabrook, McKnight’s Home Care

 

Quote:

“In a detailed report issued Thursday, the Office of Inspector General accused Medicare Advantage organizations (MAOs) of denying or delaying services to beneficiaries covered under Medicare rules. It also asserted that the plans denied payments to providers for services that met Medicare coverage rules and MA billing rules. The report follows persistent industry criticisms of MA plans, including their low payments to home care firms. … The OIG urged the Centers for Medicare & Medicaid Services to issue new guidance on appropriate use of MA clinical criteria in medical necessity reviews, update its audit protocols in MAOs and direct MAOs to take steps addressing vulnerabilities that can lead to review and system errors.”

 

 

LTC Comment, Stephen A. Moses, President, Center for Long-Term Care Reform:

Put an extra layer of administration and funding between the patient and the provider and this is bound to happen.