OIG Begins Investigation into Medicaid Managed Care Denials

Posted by Rebecca Brommel on Monday, April 22, 2019

The United States Department of Health and Human Services’ Office of Inspector General (“OIG”) recently announced that it is investigating denials by managed care organizations (“MCOs”) that contract with state Medicaid agencies.  It its announcement, OIG recognized that the arrangement between MCOs and the State “shifts financial risk for the costs of Medicaid services from the State Medicaid agency and the Federal Government to the MCO, which can create an incentive to deny beneficiaries’ access to covered services.”  OIG indicated that its review will determine whether MCOs complied with federal requirements and will review medical, dental and drug prescription prior authorizations.  Iowa news sources are reporting that the investigation includes Iowa’s managed care program.

OIG’s announcement can be located here:  https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-summary-0000370.asp

News reports can be located here:

https://www.thegazette.com/subject/news/health/federal-officials-launch-investigation-into-medicaid-managed-care-denials-including-those-in-iowa-20190417

https://whotv.com/2019/04/17/federal-investigation-into-medicaid-oversight-takes-national-aim/