Dr. Oz would seek to modernize MA 

WASHINGTON – While he’s on record as a big supporter of Medicare Advantage, Dr. Mehmet Oz told the Senate Finance Committee during a confirmation hearing on Friday that, if confirmed as CMS administrator, he would reform prior authorizations, which he called “a pox on the system.” 

Oz told the committee that he would push for reducing the some 15,000 procedures and medications that require prior auths to 1,000. He also said he would push for speeding up approvals. 

“If you're going to have a knee replacement and you can bend your knee more than 120 degrees, you don't get to get the knee replacement – or whatever number you want to put in there,” he said. “And then, if we know those numbers ahead of time, like a credit card – credit card approval doesn't take you three months – you know immediately whether the transaction's approved or not. We will be able to do something similar so that pre-authorization could happen rapidly.” 

Oz, maybe best known for The Dr. Oz Show, is a graduate of Harvard College, the University of Pennsylvania, and Wharton Business School, and a former faculty member and full professor at Columbia University College of Physicians and Surgeons. He also led Columbia University Surgical Labs, where he published hundreds of original peer-reviewed papers and wrote 16 books. 

When asked about Medicare Advantage plans using AI to improperly deny prior auths, Oz told the committee that “we should be using AI in the agency to be able to tell what insurance companies are doing with their AI.” 

“The best way to detect bank fraud is not a person looking at whether a fraudster is going in to steal money because most of us aren't thinking about fraud, so you're not very good at protecting it,” he said. “If we see that there's something being done – for example, inappropriate use of AI or inappropriate denial of services with AI – we should be using AI within the agency to identify that early enough that we can prevent it and we should do it real time, not six months down the road.”  

Oz also told the committee that he would reform upcoding by Medicare Advantage plans – a major reason why recent assessments by government agencies have found that Medicare spends more on these plans than traditional Medicare. 

“So, it's upside down,” he said. “And I think there are ways for us to look, for example, at the upcoding that's happening systemically in many programs to make sure that people who are being appropriately paid for taking care of sick patients but not for patients who aren't ill…I think we have numerous tools, but part of this is just recognizing there is a new sheriff in town.”  

Oz later told the committee that upcoding would be a topic “that is relatively enjoyable to go after, because I think we have bi-partisan support.” 

Try as senators might, however, Oz shared little about his thoughts on the Republican budget plan and whether or not it will require significant cuts to Medicaid. 

“I want to make sure that the patients today and in the future have resources to protect them if they get ill,” he said. “The way you protect Medicaid is by making sure that it's viable at every level, which includes having enough practitioners to afford the services, paying them enough to do what you request of them, and making sure that patients are able to actually use Medicaid.”