Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care

What's New

May 3, 2022

Updated: Civil Monetary Penalties and Affirmative Exclusions

May 2, 2022

Advisory Opinion 22-10 - Modification of Advisory Opinion 15-14

April 28, 2022

Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care OEI-09-18-00260

Eye on Oversight Video: Medicare Advantage Denials of Care

Enforcement Actions

May 2, 2022; U.S. Attorney's Office, Southern District of New York

U.S. Attorney Announces Settlement Of Fraud Lawsuit Against Online Pharmacy For Overdispensing Insulin

April 28, 2022; U.S. Department of Justice

Doctor Sentenced in $12 Million Medicare Fraud and Device Adulteration Scheme

April 28, 2022; U.S. Department of Justice

Pharmacy Owner Pleads Guilty in Health Care Fraud and Kickback Scheme

What's Trending

1. Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care
2. Fraud Alert: COVID-19 Scams
3. Review of the Department of Health and Human Services' Compliance with the Federal Information Security Modernization Act of 2014 for Fiscal Year 2021
4. Dr. Meir Daller Agreed to Pay $455,000 and Be Excluded for 3 Years for Allegedly Violating the Civil Monetary Penalties Law by Submitting False and Medically Unnecessary Claims Associated with Urology Services
5. Medical Identity Theft