French Hill has awarded his latest Golden Fleece Award to the Centers for Medicare and Medicaid Services, accusing the agency of failing to properly oversee Medicare Advantage prior authorization practices that impact seniors and healthcare providers across the country.
Hill announced the award after reports from the Department of Health and Human Services Inspector General found Medicare Advantage plans improperly denied some medical claims that already met coverage rules or had previously been approved.
According to the report, 18% of denied claims reviewed should have been covered under Medicare Advantage rules. The findings also pointed to administrative failures involving lost records, improperly linked files, and software problems.
Hill said CMS has a responsibility to ensure Medicare Advantage plans properly manage prior authorization systems and protect seniors from delayed medical care.
“CMS failing to efficiently or appropriately use prior authorization is unacceptable,” Hill said. “Medicare exists to protect our seniors, and they are the ones who suffer most when the system fails. CMS needs to fix this now.”
Prior authorization is used by insurance providers to approve expensive or specialized medical procedures before treatment occurs. While the process is intended to reduce fraud and unnecessary spending, critics argue delays and improper denials can harm patients and increase costs later.
Hill also highlighted the economic impact of insurance paperwork, citing estimates that insurance-related administrative costs total approximately $31 billion annually in the United States. He noted a portion of those expenses stem from appeals and filings connected to improper denials.
In a letter sent to CMS Administrator Dr. Mehmet Oz, Hill called on the agency to strengthen oversight of Medicare Advantage plans and requested notification if additional congressional authority is needed to improve enforcement.
Hill also copied HHS Inspector General March Bell on the letter as part of his ongoing federal spending accountability efforts through the Golden Fleece Award program.
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