Prior authorization and $2.75 billion in alleged fraud
Next time you see someone railing against prior authorization, give them 2.75 BILLION reasons why we need a functional process.
Yes, legitimate claims should be approved.
Yes, doctors' and patients' voices matter.
Yes, prior authorization done wrong causes delays in care.
Yes, some doctors and patients also commit fraud.
Yes, we pay for the fraud across the economy.
Yes, prior authorization done right helps to mitigate fraud, overuse, and waste.
We need a functional prior authorization system, one that harnesses the depth and detail of data available along with strong analytics to make sure that patients get the care they need without paying providers who do not provide care, or overbill for care.
Eliminating prior authorization is a foolish policy that will lead to huge increases in fraud, overuse, and waste.
Originally posted on LinkedIn, where the discussion and source links live in the comments.