HHS OIG reports Medicare Advantage plans deny skilled nursing, rehab care at high rates

The HHS Office of Inspector General found Medicare Advantage plans frequently deny prior authorization requests for post‑acute care in skilled nursing facilities and inpatient rehabilitation hospitals. The OIG identified a pattern where denials often lack a sufficient clinical rationale or do not adhere to Medicare coverage criteria. While some denials are reversed on appeal, the process delays necessary care and burdens provider staff. This report signals intensified federal scrutiny of MA plan utilization management. Track the MA plan audit activity for your region; prepare for possible CMS enforcement actions around coverage determinations for SNF and IRF admissions.