OIG Report Blasts Prior Authorization Use in Medicare Advantage Plans

The HHS Office of Inspector General (OIG) has issued a critical report on prior authorization practices within Medicare Advantage plans, citing high rates of inappropriate denials and delays. The report underscores findings that a significant portion of prior authorization requests for services that meet Medicare coverage rules are still denied by MA plans, with appeals often overturning these decisions. This adds regulatory and political pressure on CMS to enforce existing rules and potentially tighten oversight. For practices, this report validates the operational burden of MA prior auths but does not change immediate workflows. It does, however, strengthen the case for appealing MA denials, as the OIG data suggests a high likelihood of reversal.