HHS Announces Investigation into Use of Prior Authorization for Post-Acute Care

The Department of Health and Human Services’ Office of Inspector General announced last week that it plans to investigate Medicare Advantage organizations’ denials of prior authorization for post-acute care after a qualifying hospital stay.

“Medicare Advantage plans must cover at least the same services as original Medicare, but Medicare Advantage Organizations (MAOs) may impose additional administrative requirements, such as requiring prior authorization before certain services can be provided,” the OIG said on its website. “We will review some MAOs’ processes for reviewing prior authorization requests for post-acute care in long-term acute care hospitals, inpatient rehabilitation centers, and skilled nursing facilities. We will also examine the extent to which selected MAOs denied post-acute care requests and examine the care settings in which patients were discharged from the hospital.” The OIG plans to publish its findings in 2026.