Congress Launches MCO Investigation

House Energy and Commerce Committee Ranking Member Frank Pallone, Jr. (D-NJ) and Senate Finance Committee Chair Ron Wyden (D-OR) today sent a series of letters to the largest Medicaid Managed Care Organizations (MCOs) across the country as part of a new investigation seeking answers following reports of high rates of prior authorization denials for patients.  

An alarming report by the Department of Health and Human Services (HHS) Inspector General found that numerous Medicaid MCOs had staggeringly high rates of denial of health services for patients.  The HHS Inspector General report found that MCOs denied, on average, one out of every eight prior authorization requests for service-a denial rate of 12.5 percent, which is more than double the denial rate in Medicare Advantage.

Letters were sent to Aetna, AmeriHealth Caritas, CareSource, Centene, Elevace, Molina and United Healthcare.