Submitting OIG:
Report Description:
A central concern about the capitated payment model used in Medicare Advantage is the potential incentive for MAOs to inappropriately deny access to services and payment in an attempt to increase their profits. An MAO that inappropriately denies authorization of services for beneficiaries, or payments to health care providers, may contribute to physical or financial harm and also misuses Medicare Program dollars that CMS paid for beneficiary healthcare. Because Medicare Advantage covers so many beneficiaries (more than 20 million in 2018), even low rates of inappropriately denied services or payment can create significant problems for many Medicare beneficiaries and their providers.
Date Issued:
Tuesday, September 25, 2018
Agency Reviewed / Investigated:
Submitting OIG-Specific Report Number:
OEI-09-16-00410
Component, if applicable:
Centers for Medicare & Medicaid Services
Location(s):
Agency-Wide
Type of Report:
Inspection / Evaluation
Questioned Costs:
$0
Funds for Better Use:
$0
Number of Recommendations:
3
View Document:
Attachment | Size |
---|---|
oei-09-16-00410.pdf | 2.16 MB |
Additional Details Link: