The Honorable Brian M. Boynton
Acting Assistant Attorney General, Civil Division
Department of Justice
950 Pennsylvania Avenue, NW
Washington, D.C. 20044

Dear Acting Assistant Attorney General Boynton:

On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners — including more than 270,000 affiliated physicians, ² million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the American Hospital Association (AHA) urges you to establish a task force to conduct False Claims Act investigations into commercial health insurance companies that are found to routinely deny patients access to services and deny payments to health care providers.

Earlier this month, the Department of Health and Human Services’ Office of Inspector General (HHS-OIG) released an alarming report entitled “Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care.”¹ As you know, the Medicare Advantage program is designed to cover the same services as original Medicare, and by law, Medicare Advantage Organizations (MAOs) may not impose additional clinical criteria that are “more restrictive than original Medicare’s national and local coverage policies.”² HHS-OIG found that some of America’s largest MAOs have been violating this basic legal obligation at a staggering rate.

Using a random sample of...

Read Full Story: https://www.aha.org/lettercomment/2022-05-19-aha-department-justice-re-false-...