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Reports: Medicare Advantage Plans Improperly Denying Claims

Posted on Friday, October 19, 2018 7:32 PM

According to both the Office of the Inspector General (OIG) of the Department of Health and Human Services and the New York Times, Medicare Advantage plans are improperly denying claims to patients and hospitals. 

One third of Medicare beneficiaries, which equates to approximately 20 million people, are covered by Medicare Advantage plans.  “Because Medicare Advantage covers so many beneficiaries, even low rates of inappropriately denied services or payment can create significant problems for many Medicare beneficiaries and their providers,” reads the OIG report.

Private Medicare Advantage plans, which now cover about 20 million people, have an incentive to deny claims “to increase their profits,” according to the OIG report, whose investigators found “widespread and persistent problems related to denials of care and payment in Medicare Advantage.”

Most beneficiaries do not appeal their claim denials, even though they may not be able to afford the service related to the claim.  As a result, many beneficiaries may not seek necessary healthcare treatment.

Source: NAHC Report

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