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Some Medicare Advantage organizations are denying or delaying services to beneficiaries covered under Medicare rules, according to a report issued Thursday by the Department of Health and Human Services Office of the Inspector General. The actions affect tens of thousands of seniors with private Medicare Advantage plans, HealthDay News and other media outlets reported

The OIG reviewed a sample of 250 denials of prior authorization requests and 250 payment denials issued by 15 of the largest Medicare Advantage plans from June 1 to 7, 2019.

“Although MAOs approve the vast majority of requests for services and payment, they issue millions of denials each year, and CMS annual audits of MAOs have highlighted widespread and persistent problems related to inappropriate denials of services and payment,” according to the report.

Some plans, according to the report, denied prior authorization and payment requests that met Medicare coverage rules (18%) by using clinical criteria that are not contained in Medicare coverage rules, requesting unnecessary documentation and making manual review errors and system errors. Thirteen percent of prior authorization denials were for service requests that met Medicare coverage rules, likely preventing or delaying medically necessary care for Medicare Advantage beneficiaries, the OIG said.

“What this report really highlights is just how important it will be for MA plans to develop better and more sophisticated approaches to managing care to lower costs, rather than relying on the more traditional methods. Many plans are moving quickly to acquire assets that will enable this,” ATI Advisory CEO Anne Tumlinson told the McKnight’s Business Daily.

Several long-term care operators offer Medicare Advantage plans to their residents, among them the Perennial Consortium, which includes Juniper Communities, Christian Living Communities, Ohio Living and AllyAlign Health. Additionally, LeadingAge California and AllyAlign Health also partnered to offer access to Align Senior Health Medicare Advantage plans. Another example is Erickson Senior Living, which offers a Medicare Advantage plan through Erickson Advantage.

“It is really important for the government, in its oversight role, to manage the tension between giving beneficiaries insurance options that are low cost and making sure they retain the access to which they are entitled,” she added. “We must manage this, especially for post-acute care, where I would argue where much of this tension occurs. The post-acute care SNFs do not have, as individual organizations, the market power to push back.”