Private Medicare Plans Faulted by Watchdog Over Denials of Care

A report from the Health and Human Services Office of Inspector General warns that privately-run Medicare health plans may be improperly denying beneficiaries medical care, according to Bloomberg . Federal auditors claim they have found "widespread and persistent problems related to denials of care and payment in Medicare Advantage." Such plans assess a fixed fee from the government for caring for people 65 or older who qualify for traditional Medicare coverage, and the report suggests the fixed rates the government pays may give plans "an incentive to deny preauthorization of services for beneficiaries, and payments to providers, in order to increase profits." The auditors determined Medicare Advantage plans in 2016 denied 4 percent of requests to approve treatment before it was provided and 8 percent of requests for payment after treatment. Just 1 percent of beneficiaries disputed the insurers' denials, but in those cases, the decisions were overturned most of the time. Improper denials "may contribute to physical harm for beneficiaries if they're not getting access to services that they need," says Rosemary Rawlins with the Inspector General. She also points out that the Centers for Medicare and Medicaid Services audit different organizations every year, "but consistently find problems related to denials of care and payment."