Becker’s Healthcare has published an article headlined “Hospitals are dropping Medicare Advantage left and right” due to denials and late payments. As the president and CEO of Scripps Health, Chris Van Gorder, stated in the article: “It’s become a game of delay, deny and not pay.” The article also cites the example of the St. Charles Health System in Bend, Oregon, which is not only considering terminating its Medicare Advantage contracts, but is also encouraging Medicare eligible patients not to enroll in these plans due to “high rates of denials, longer hospital stays and overall administrative burden for clinicians.”
Scripps and St. Charles are only two of many hospitals that are terminating or contemplating terminating their Medicare Advantage contracts. In addition to Scripps and St. Charles, the article lists seven other hospitals that have recently terminated some or all of their participation agreements with Medicare Advantage plans.
These hospitals’ experience with Medicare Advantage plans was confirmed by an April 2023 report by the Department of Health and Human Services Office of the Inspector General entitled Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care.
Whatley Kallas, LLP has represented hospitals around the country that have also experienced significant inappropriate denials and delays in payment by Medicare Advantage plans, some of which have also terminated or seriously considered terminating their Medicare Advantage contracts.