OIG Announces Plan to Examine Medicare Advantage Use of Prior Authorizations in Post-Acute Care

Regulations; Compliance; Medicare Advantage
In its June monthly work plan update, the Office of the Inspector General (OIG) announced its plan to investigate the use of prior authorizations for post-acute care by Medicare Advantage Organizations (MAOs). The OIG will be examining plan procedures for reviewing prior authorizations, the scope of denials, and the care settings to which patients are discharged following hospitalizations.

AHCA, along with representatives from other leading post-acute care associations, including LeadingAge, NALTH, and NAHC, met with OIG staff earlier this year to share member challenges and recommend opportunities to ensure Medicare Advantage (MA) beneficiaries receive the benefits for which they are eligible under traditional fee-for-service Medicare.

The OIG will publish its findings in a 2026 report. Additionally, the OIG will be a​uditing the supplemental benefits offered by MA​ plans for compliance with federal requirements. This report will be released in 2025.