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Kansas Inspector General reports KanCare prior‑authorization delays and inconsistent post‑acute determinations
Summary
An Office of Inspector General performance audit covering 2021–2023 found delays in peer‑to‑peer reviews, frequent use of observation status where hospitals treated patients as inpatients, inconsistent MCO post‑acute care decisions, and potential conflicts of interest in claims‑review tools.
Stephen Anderson, Kansas Inspector General, briefed the Senate Committee on Government Efficiency on a performance audit of managed care organization (MCO) prior‑authorization and claims practices in Kansas Medicaid (KanCare). The audit covered Jan. 1, 2021, through Dec. 31, 2023, and was published on Oct. 2; the IG reported 17 findings, 42 recommendations and 12 observations.
The audit identified three primary problem areas: delays in peer‑to‑peer reviews that slowed access to critical care; widespread use of observation status where hospital clinicians judged inpatient admission appropriate; and inconsistent MCO determinations for post‑acute care authorizations. Anderson summarized an operational consequence: "If you're in the hospital, you're an inpatient,"…
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