OIG Finds Health Share of Oregon Failed Federal Requirements in Prior Authorization Denials

The HHS Office of Inspector General found that Health Share of Oregon, a Medicaid coordinated care organization, did not always comply with federal and state requirements when denying prior authorization requests. The audit identified deficiencies in the CCO's denial processes, including inadequate documentation and failure to meet regulatory standards for timely and appropriate prior authorization determinations. Health Share of Oregon serves Medicaid beneficiaries in the Portland metro area under Oregon's 1115 waiver. The findings carry implications for federal compliance oversight of Medicaid managed care organizations' utilization management practices.

Managed Care