Healthcare Finance News (5/23, Lagasse) reports, “The American Hospital Association has sent a letter to the U.S. Department of Justice asking it to investigate routine denials from major health insurance companies.” Furthermore, “the AHA recommended that the DOJ establish a task force ‘to conduct False Claims Act investigations into commercial health insurance companies that are found to routinely deny patients access to services and deny payments to health care providers.’” This “recommendation was based in large part on a recent report released by the” HHS OIG, titled, “Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care.” The report “garnered reaction from” American Medical Association President Gerald E. Harmon, M.D., who said the report “uncovered information that mirrors physician experiences.” He added, “Surveys of physicians have consistently found that excessive authorization controls required by health insurers are persistently responsible for serious harm when necessary medical care is delayed, denied, or disrupted.”
Related Links:
— “AHA presses Department of Justice to investigate routine denials from health insurers “Jeff Lagasse, Healthcare Finance News, May 23, 2022