Fraud Health Insurance Managed Care Medicare

The Start of Rationing in Medicare?

Prior authorization is a common tool that managed care organizations use to reduce patient utilization of medical services.  Some physicians believe that prior authorization creates barriers to effective care, but other commentators believe that prior authorizations can be implemented in a more efficient manner.  Either way, prior authorizations are a form of rationing care.

Although Medicare typically has not required patients to seek prior authorizations to use specific services, this may be changing with the start of the Prior Authorization for Power Mobility Devices Demonstration.

This demonstration will implement a Prior Authorization process for scooters and power wheelchairs for all people with Medicare who reside in seven states with high populations of fraud- and error-prone providers (CA, IL, MI, NY, NC, FL and TX). This demonstration is designed to develop and demonstrate improved methods for the investigation and prosecution of fraud in the provision of care or services under the health programs established by the Social Security Act. This demonstration will also help ensure that a beneficiary’s medical condition warrants their medical equipment under existing coverage guidelines.

Even though this prior authorization application seems reasonable, this could be the start of additional forms of rationing.  Rationing, however, may not necessarily be a bad thing.  Reducing unnecessary expenditures so that Medicare can become more fiscally solvent is a desirable outcome.  The key is how services are rationed.


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