Medicare Advantage Appeal Outcomes & Audit Findings Raise Concerns About Service & Payment Denials

This report was released on September 28, 2018 by the U.S. Department of Health & Human Services’ (DHS’) Office of the Inspector General (OIG). The OIG collected data on denials, appeals, and appeal outcomes at each level of the Medicare Advantage appeals process for 2014 to 2016. The goal was to determine the prevalence of inappropriately denied services or payment by Medicare Advantage organizations . . .