tci Medicare Compliance & Reimbursement - 2022 Issue Q2

Compliance: OIG Reveals MA Care Denial Issues in New Report

Warning: MA plans are now under OIG’s watchful eye. Whether you’re new to Medicare Advantage (MA) or your organization’s been a provider for years, you should expect heightened scrutiny of the care you offer to your beneficiaries, a new HHS Office of Inspector General suggests. “Our case file reviews determined that [Medicare Advantage Organizations] sometimes delayed or denied Medicare Advantage beneficiaries’ access to services, even though the requests met Medicare coverage rules,” the OIG says in a new report on the topic (OEI-09-18-00260). “MAOs also denied payments to providers for some services that...

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