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Sunday 26 November 2023

Derek Chauvin’s family has received no updates after prison stabbing, attorney says


MINNEAPOLIS — An attorney for Derek Chauvin, the former Minneapolis police officer convicted of murdering George Floyd, said Saturday that Chauvin’s family has been kept in the dark by federal prison officials after he was stabbed in prison.

The lawyer, Gregory M. Erickson, slammed the lack of transparency by the Federal Bureau of Prisons a day after his client was stabbed on Friday by another inmate at the Federal Correctional Institution in Tucson, Arizona, a prison that has been plagued by security lapses and staffing shortages.

A person familiar with the matter told The Associated Press on Friday that Chauvin was seriously injured in the stabbing. The person spoke to the AP on condition of anonymity because they were not authorized to publicly discuss the attack. On Saturday, Brian Evans, a spokesperson for the Minnesota attorney general’s office, said: “We have heard that he is expected to survive.”

Erickson said Chauvin’s family and his attorneys have hit a wall trying to obtain information about the attack from Bureau of Prisons officials. He said Chauvin’s family has been forced to assume he is in stable condition, based only on news accounts, and has been contacting the prison repeatedly seeking updates but have been provided with no information.

“As an outsider, I view this lack of communication with his attorneys and family members as completely outrageous,” Erickson said in a statement to the AP. “It appears to be indicative of a poorly run facility and indicates how Derek’s assault was allowed to happen.”

Erickson’s comments highlight concerns raised for years that federal prison officials provide little to no information to the loved ones of incarcerated people who are seriously injured or ill in federal custody. The AP has previously reported the Bureau of Prisons ignored its internal guidelines and failed to notify the families of inmates who were seriously ill with COVID-19 as the virus raged through federal prisons across the U.S.

The issue around family notification has also prompted federal legislation introduced last year in the U.S. Senate that would require the Justice Department to establish guidelines for the Federal Bureau of Prisons and state correctional systems to notify the families of incarcerated people if their loved one has a serious illness, a life-threatening injury or if they die behind bars.

“How the family members who are in charge of Derek’s decisions regarding his personal medical care and his emergency contact were not informed after his stabbing further indicates the institution’s poor procedures and lack of institutional control,” Erickson said of the prison.

A spokesperson for the Bureau of Prisons did not immediately respond to a request for comment Saturday evening.

The Bureau of Prisons has only confirmed an assault at the Arizona facility and said employees performed “life-saving measures” before the inmate was taken to a hospital for further treatment and evaluation. The Bureau of Prisons did not name the victim or provide a medical status “for privacy and safety reasons.”

Prosecutors who successfully pursued a second-degree murder conviction against Chauvin at a jury trial in 2021 expressed dismay that he became the target of violence while in federal custody.

Terrence Floyd, George Floyd’s brother, told the AP on Saturday that he wouldn’t wish for anyone to be stabbed in prison and that he felt numb when he initially learned of the news.

“I’m not going to give my energy towards anything that happens within those four walls — because my energy went towards getting him in those four walls,” Terrence Floyd said. “Whatever happens in those four walls, I don’t really have any feelings about it.”

Chauvin’s stabbing is the second high-profile attack on a federal prisoner in the last five months. In July, disgraced sports doctor Larry Nassar was stabbed by a fellow inmate at a federal penitentiary in Florida.

Chauvin, 47, was sent to FCI Tucson from a maximum-security Minnesota state prison in August 2022 to simultaneously serve a 21-year federal sentence for violating Floyd’s civil rights and a 22½-year state sentence for second-degree murder.

Another of Chauvin’s lawyers, Eric Nelson, had advocated for keeping him out of the general population and away from other inmates, anticipating he’d be a target. In Minnesota, Chauvin was mainly kept in solitary confinement “largely for his own protection,” Nelson wrote in court papers last year.

Last week, the U.S. Supreme Court rejected Chauvin’s appeal of his murder conviction. Separately, Chauvin is making a longshot bid to overturn his federal guilty plea, claiming new evidence shows he didn’t cause Floyd’s death.

Floyd, who was Black, was killed May 25, 2020, after Chauvin, who is white, pressed a knee on his neck for 9½ minutes on the street outside a convenience store where Floyd was suspected of trying to pass a counterfeit $20 bill.

Bystander video captured Floyd’s fading cries of “I can’t breathe.” His death touched off protests worldwide, some of which turned violent, and forced a national reckoning with police brutality and racism.

Three other former officers who were at the scene received lesser state and federal sentences for their roles in Floyd’s death.

Chauvin’s stabbing comes as the federal Bureau of Prisons has faced increased scrutiny in recent years following wealthy financier Jeffrey Epstein’s jail suicide in 2019. It’s another example of the agency’s inability to keep even its highest profile prisoners safe after Nassar’s stabbing and “Unabomber” Ted Kaczynski’s suicide at a federal medical center in June.

At the federal prison in Tucson in November 2022, an inmate at the facility’s low-security prison camp pulled out a gun and attempted to shoot a visitor in the head. The weapon, which the inmate shouldn’t have had, misfired and no one was hurt.




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Trump draws cheers in Haley's backyard at Clemson-South Carolina football game


COLUMBIA, S.C. — Donald Trump used college football rivalry weekend to bask among his supporters in a state and region that are key to his presidential fortunes, while trying to upstage his Republican opponent Nikki Haley on her home turf at the Clemson-South Carolina football game.

The former president and current front-runner for the 2024 Republican nomination arrived at Williams-Brice Stadium in Columbia on Saturday night to chants of “We want Trump! We want Trump!” from fans gathered for the annual Palmetto Bowl, the state's biggest sporting event of the year.

Haley, a Clemson alumna and trustee who was twice elected South Carolina governor, did not attend.

Trump was a guest of Gov. Henry McMaster, Haley's successor. The entourage, which entered through a veritable tunnel of Trump supporters on its way to a private suite, also included South Carolina's senior U.S. Sen. Lindsey Graham, giving the former president a show of local political force at a game featuring Haley's alma mater, Clemson, where she is also a member of the board of trustees.

McMaster ascended to the governor's office in 2017 when Trump elevated Haley to United Nations ambassador. Graham and Haley have mostly been allies over the years. But both men now back Trump, and the former president enjoys a wide polling lead among Republican primary voters. That includes nationally and in early nominating states like South Carolina.

Hours before kickoff, Trump’s campaign announced that he had been endorsed by “more South Carolina legislators than all opposing candidates combined,” including new backing from six state lawmakers who had previously supported U.S. Sen. Tim Scott, before the South Carolinian ended his presidential bid earlier this month.

Columbia was primed for Trump's visit. Around the stadium Saturday afternoon, more than a half-dozen electronic billboards around the capital city of Columbia boasted a message noting Trump's 2020 election loss and his pending legal cases: “You lost. You're guilty. Welcome to Columbia, Donald.”

Some vendors around the venue, meanwhile, hawked Trump-related merchandise, including “Trump 2020” flags, from the previous election cycle. And some fans entering the stadium before Trump's arrival chanted “Let's Go Brandon!” — a derogatory reference to President Joe Biden, who defeated Trump in 2020.

“We do it big time in the South,” said Brandon Beach, a Georgia state senator and top Trump supporter, explaining why Trump would choose to come to the Palmetto Bowl. “President Trump knows he can connect with people, and they are going to connect with him.”

Asked about the coming primary matchup with Trump, Haley spokesperson Olivia Perez-Cubas called her “the only candidate with momentum” and referenced Haley's previous come-from-behind victories.

“South Carolinians know their governor has what it takes to win because they’ve seen her beat the odds before — not just once, but twice,” she said.

Trump has enjoyed tweaking Haley in her own state before. “In 2016, South Carolina gave us 44 out of 46 counties – that’s not so bad,” he said at a state GOP dinner in August. “I can’t wait to win all 46. We want to win all 46.”

South Carolina falls fourth in the GOP voting calendar after Iowa, New Hampshire and Nevada, with the state's first-in-the-South primary coming up on Feb. 24, 2024. Several Southern states follow on March 5 as part of the Super Tuesday slate that puts more delegates up for grabs than any other day in the primary campaign.

Trump’s South Carolina and Super Tuesday romps in 2016 gave him a delegate lead he would never relinquish.

Haley has answered Trump in recent weeks by emphasizing her roots as she campaigns in Iowa, which opens voting nationally with its Jan. 15 caucuses.

“I’m not going anywhere,” she said recently in Ankeny, predicting a strong showing in the caucuses. “Then I go head-to-head with Trump in my home state of South Carolina. And we take it.”

Trump, who tried to buy an NFL team in the 1980s and ended up part of a failed alternative league, has enjoyed sports cameos over the years. But college football has afforded him his most generous welcomes. Earlier this fall, he attended the Iowa State-Iowa game in Ames, Iowa, including stopping at a fraternity house before kickoff. And while he was president, he attended the 2018 national championship game in Atlanta and the 2019 Alabama-LSU regular season game in Tuscaloosa, Alabama.

That Alabama game came just days after Trump was booed by professional baseball fans when he attended a World Series home game of the Washington Nationals.



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Mediators: Gaza hostage releases to resume after Israel-Hamas dispute


A second group of Gaza hostages is set to be released later Saturday after a delay that followed a dispute between Israel and Hamas over the terms of a truce agreement, according to Qatari government officials.

Qatari foreign ministry spokesperson Dr. Majid bin Mohammed Al Ansari confirmed that the hostage transfer would resume.

“After a delay, obstacles to release of prisoners were overcome through Qatari-Egyptian contacts with both sides, and 39 Palestinian civilians will be released tonight, while 13 Israeli hostages will leave Gaza in addition to 7 foreigners,” Al Ansari wrote in a message posted to X, formerly known as Twitter, on Saturday afternoon.

The delay, first reported by Reuters, came as Hamas’ armed wing said it would not release the second round of hostages until Israel held up its side of the deal: allowing aid trucks to enter the besieged northern Gaza region.

Israel maintained that it had not violated the agreement. Thousands of protesters gathered in Tel Aviv to demand the release of the second group of hostages following the news of the delay.

The hostage transfer is part of a broader four-day truce agreement brokered by Qatar, Egypt and the U.S. that started Friday.



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Saturday 25 November 2023

Ex-officer Derek Chauvin, convicted in George Floyd's killing, stabbed in prison, AP source says


Derek Chauvin, the former Minneapolis police officer convicted of murdering George Floyd, was stabbed by another inmate and seriously injured Friday at a federal prison in Arizona, a person familiar with the matter told The Associated Press.

The attack happened at the Federal Correctional Institution, Tucson, a medium-security prison that has been plagued by security lapses and staffing shortages. The person was not authorized to publicly discuss details of the attack and spoke to the AP on the condition of anonymity.

The Bureau of Prisons confirmed that an incarcerated person was assaulted at FCI Tucson at around 12:30 p.m. local time Friday. In a statement, the agency said responding employees contained the incident and performed “life-saving measures” before the inmate, who it did not name, was taken to a hospital for further treatment and evaluation.

No employees were injured and the FBI was notified, the Bureau of Prisons said. Visiting at the facility, which has about 380 inmates, has been suspended.

Messages seeking comment were left with Chauvin’s lawyers and the FBI.

Chauvin’s stabbing is the second high-profile attack on a federal prisoner in the last five months. In July, disgraced sports doctor Larry Nassar was stabbed by a fellow inmate at a federal penitentiary in Florida.

It is also the second major incident at the Tucson federal prison in a little over a year. In November 2022, an inmate at the facility’s low-security prison camp pulled out a gun and attempted to shoot a visitor in the head. The weapon, which the inmate shouldn’t have had, misfired and no one was hurt.

Chauvin, 47, was sent to FCI Tucson from a maximum-security Minnesota state prison in August 2022 to simultaneously serve a 21-year federal sentence for violating Floyd’s civil rights and a 22½-year state sentence for second-degree murder.

Chauvin’s lawyer, Eric Nelson, had advocated for keeping him out of general population and away from other inmates, anticipating he’d be a target. In Minnesota, Chauvin was mainly kept in solitary confinement “largely for his own protection,” Nelson wrote in court papers last year.

Last week, the U.S. Supreme Court rejected Chauvin’s appeal of his murder conviction. Separately, Chauvin is making a longshot bid to overturn his federal guilty plea, claiming new evidence shows he didn’t cause Floyd’s death.

Floyd, who was Black, died on May 25, 2020, after Chauvin, who is white, pressed a knee on his neck for 9½ minutes on the street outside a convenience store where Floyd was suspected of trying to pass a counterfeit $20 bill.

Bystander video captured Floyd’s fading cries of “I can’t breathe.” His death touched off protests worldwide, some of which turned violent, and forced a national reckoning with police brutality and racism.

Three other former officers who were at the scene received lesser state and federal sentences for their roles in Floyd’s death.

Chauvin’s stabbing comes as the federal Bureau of Prisons has faced increased scrutiny in recent years following wealthy financier Jeffrey Epstein’s jail suicide in 2019. It's another example of the agency’s inability to keep even its highest profile prisoners safe after Nassar’s stabbing and “Unabomber” Ted Kaczynski’s suicide at a federal medical center in June.

An ongoing AP investigation has uncovered deep, previously unreported flaws within the Bureau of Prisons, the Justice Department’s largest law enforcement agency with more than 30,000 employees, 158,000 inmates and an annual budget of about $8 billion.

AP reporting has revealed rampant sexual abuse and other criminal conduct by staff, dozens of escapes, chronic violence, deaths and severe staffing shortages that have hampered responses to emergencies, including inmate assaults and suicides.

Bureau of Prisons Director Colette Peters was brought in last year to reform the crisis-plagued agency. She vowed to change archaic hiring practices and bring new transparency, while emphasizing that the agency's mission is “to make good neighbors, not good inmates."

Testifying before the Senate Judiciary Committee in September, Peters touted steps she'd taken to overhaul problematic prisons and beef up internal affairs investigations. This month, she told a House Judiciary subcommittee that hiring had improved and that new hires were outpacing retirements and other departures.

But Peters has also irritated lawmakers who said she reneged on her promise to be candid and open with them. In September, senators scolded her for forcing them to wait more than a year for answers to written questions and for claiming that she couldn’t answer basic questions about agency operations, like how many correctional officers are on staff.



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Biden hails first hostage releases under Israel-Hamas deal, warns of challenges ahead


President Joe Biden on Friday framed Hamas’ initial release of two dozen women and children as a sign of progress but emphasized that the deal was just the beginning of a challenging road ahead as the U.S. works to free the remaining hostages, including American citizens.

“Today has been a product of a lot of hard work and weeks of personal engagement,” Biden said, speaking from Nantucket, Massachusetts, where he’s spending the Thanksgiving holiday with his family. “From the moment Hamas kidnapped these people, I, along with my team, have worked around the clock to secure their release.”

Hamas released the first hostages Friday — 13 Israelis, 10 Thai citizens and one Filipino. Their release marked the first wave in a deal to trade several hostages for Palestinian prisoners in Israel under a four-day cease-fire. Biden said more details will be unveiled about the next round of hostages in the coming hours, but it’s not yet clear if that list will include Americans.

“We don’t know when that will occur, but we expect it to occur. And we don’t know what the list of all the hostages are or when they’ll be released, but we know the numbers when they’re going to be released. So my hope and expectation is that it will be soon,” Biden said, responding to a question from a reporter about when Americans will be released.

Under the agreement announced earlier this week, Hamas is expected to release a total of 50 hostages for 150 Palestinian prisoners, all women and teenagers. The deal, which emerged from talks involving Israel, Hamas, Qatar, the U.S. and several outside groups, could be seen as a rare bright spot amid several weeks of death and devastation. More than two hundred trucks also arrived in Gaza on Friday, carrying fuel, food, medicine and cooking gas, Biden said, and hundreds more are expected to arrive in the coming days.

“I don’t trust Hamas to do anything right,” Biden said of the ongoing negotiations. “I only trust Hamas to respond to pressure.”

While several administration officials say the deal is evidence that their strategy toward the Israel-Hamas war is working, the president didn’t take a victory lap on Friday, as roughly 200 hostages will remain in captivity.

The hostages suffered immeasurable trauma, Biden said.

“All of these hostages have been through a terrible ordeal. And this is the beginning of a long journey of healing for them,” Biden said. “The teddy bears waiting to greet those children at the hospital are a stark reminder of the trauma these children have been through at such a very young age.”

Hamas killed 1,200 people Oct. 7, and Israel’s response has killed more than 13,000 people.

The political challenge facing the president is far from fading as progressive-minded Democrats ramp up calls for a cease-fire. Biden said Friday that he’s encouraged Israeli Prime Minister Benjamin Netanyahu to “focus on trying to reduce the number of casualties,” while trying to eliminate Hamas, which he called a legitimate objective.

Biden also faces an uphill climb in securing aid for Israel, as some members of his party call for conditions attached to aid for Israel, such as a reduction in bombing.

“I think that’s a worthwhile thought,” Biden said. “But I don’t think if I started off with that that we would’ve ever gotten to where we got today. We have to take this a piece at a time.”



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Trudeau blames ‘MAGA influence’ for stirring debate on Ukraine


Justin Trudeau is blaming the MAGA movement and Republican ideology for eroding support for Ukraine.

The Canadian prime minister used a press conference with visiting European leaders to connect a gambit by his Conservative rivals in Ottawa to hard-right rhetoric in the United States and Europe, which he said is “starting to parrot Russian disinformation and misinformation and propaganda.”

Canada is home to 1.4 million Ukrainian Canadians and boasts the second-largest Ukrainian diaspora after Russia. Until now, politicians of all stripes have been united behind Ukraine.

Conservative Leader Pierre Poilievre and his party turned heads in Parliament earlier this week when they voted as a bloc against legislation that would update the Canada-Ukraine Free Trade Agreement. The bill passed anyway with the aid of Bloc Québécois and NDP MPs for study at the committee level.

President Volodymyr Zelenskyy signed the new deal when he met with Trudeau in Ottawa this fall. Ukraine asked Canada to fast-track the modernized legislation to help lure investments to rebuild the war-torn country.

In a surprise move, Conservatives voted against legislation that would enact those changes. The party claimed that the new trade deal with Ukraine would impose Canada’s controversial carbon tax which Poilievre has vowed to kill.

No such wording actually exists in the document. In fact, the Eastern European country has had its own carbon mechanism since 2011.

Ukrainian officials were taken aback by the sudden politicization of a trade deal first championed by former Conservative Prime Minister Stephen Harper.

Trudeau called the Conservatives opposition to the deal “frankly absurd.”

During Friday’s press briefing he called out what he described as a bigger trend behind the Conservatives’ twist — using the moment to tie his political foes to Trumpian influences.

“The real story is the rise of a right-wing American, MAGA influence thinking that has made Canadian Conservatives, who used to be among the strongest defenders of Ukraine … turn their backs on something Ukraine needs in its hour of need,” Trudeau told reporters in St. John’s, Newfoundland and Labrador.

Support for Ukraine has evolved into a crisis in Washington, with calls from congressional members to pump the brakes on U.S. aid to the country. The position, most evident among a hardline group of Republicans, reflects former President Donald Trump’s “America First” ethos on foreign policy and hostility to foreign aid.

Trudeau was hosting European Council President Charles Michel and European Commission President Ursula von der Leyen in the Atlantic harbor city for a two-day leaders’ summit at which a new EU-Canada green alliance was formally announced.

Von der Leyen also confirmed that the European Union will formally join Canada’s global carbon pricing challenge to get all countries on board with emissions trading or a tax to lower emissions.

The rising cost of living has made the Trudeau government’s climate policies — especially its carbon tax — a lightning rod for partisan derision. A wave of growing support for Poilievre has been partly fueled by Conservative calls to “axe the tax.”

While Poilievre has stumped around the country, railing on the tax, he does not acknowledge the federal government rebates that Canadians receive to offset the carbon tax, which was designed to incentivize a dip in fossil fuel use and the adoption of greener energy alternatives.



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Friday 24 November 2023

Medicare Advantage plans under Congress’ microscope for care denials


Enrollment in Medicare’s private-sector alternative is surging — and so are the complaints to Congress.

More than 30 million older Americans are enrolled in Medicare Advantage plans, wooed by lower premiums and more benefits than traditional Medicare offers.

But a bipartisan group of lawmakers is increasingly concerned that insurance companies are preying on seniors, and, in some cases, denying care that would otherwise be approved by traditional Medicare.

“It was stunning how many times senators on both sides of the aisle kept linking constituent problems with denying authorizations for care,” Sen. Ron Wyden (D-Ore.) said in an interview, referring to a bevy of complaints from colleagues during a recent Senate Finance Committee hearing.

Congress has already gone after insurers for their celebrity-filled ads and misleading directories. But its scrutiny of these care denials, which is expected to continue into next year, could have a far greater impact and reshape the rules for one of the most profitable parts of the insurance industry.

“CMS is very attuned to what is going on on the Hill,” Sean Creighton, managing director of policy for consulting firm Avalere Health, said of the Centers for Medicare and Medicaid Services. He added that next year will likely bring “more scrutiny by the Hill and CMS on this, and there will be more reporting requirements for the plans and actions the plans are required to take to lessen the burden on providers and patients.”

Legislation requiring insurers to more quickly approve requests for routine care passed unanimously in the House in 2022, but stalled in the Senate over cost concerns. The Improving Seniors’ Timely Access to Care Act, which mandates insurers quickly approve requests for routine care and respond within 24 hours to any urgent request, was reintroduced this year in the House and passed out of the House Ways and Means Committee this summer as part of a larger health care package.

Still, lawmakers are peppering the Biden administration with demands for reforming the commonly used tool called prior authorization, the process in which health insurers require patients to get insurer approval ahead of time for certain treatments or medications.

It “has turned into a process of basically just stopping people from getting care,” said Rep. Pramila Jayapal (D-Wash.), leader of the House Progressive Caucus.



Jayapal was one of more than three dozen House Democrats who told CMS this month of “a concerning rise in prior authorizations,” accused health insurers of prioritizing “profits over people” and asked for “a robust method of enforcement to rein in this behavior.”

Unlike traditional Medicare, Medicare Advantage plans can employ prior authorization and restrict beneficiaries to certain doctors within their network. Those are among the incentives private insurers have to participate in the program and enrollment has doubled during the last decade.

But Sen. James Lankford (R-Okla.) said some hospitals in his state won’t take Medicare Advantage plans any more. “We can’t do it because we can’t afford the constant chasing from all the denials,” he said.

AHIP, the trade group representing insurers, told POLITICO that prior authorization was among the tools that can curb wasteful spending.

“These tools are important when coordinating care, reducing unnecessary and low-value care, and promoting affordability for patients and consumers,” said spokesperson David Allen in a statement.

CMS has a track record of responding to liberal concerns, which could translate into big changes for Medicare Advantage in the coming years. Earlier this month, it proposed a rule to improve the standards for behavioral health networks following complaints from Congress about woefully inaccurate mental health provider directories, which some lawmakers said amounted to fraud.

It also for the first time this year is evaluating Medicare Advantage television ads before they air, following prodding from lawmakers and numerous complaints from elderly consumers who felt duped by the ubiquitous ads.

CMS also proposed a rule earlier this month that plans be required to factor the impact of prior authorization denials on marginalized and underserved communities, part of a larger effort by the agency to close gaps in health equity. The rule, if finalized, would take effect in 2025.

Sen. Elizabeth Warren (D-Mass.), who wants the agency to go further, has proposed an amendment that would require CMS to collect and publish data from Medicare Advantage plans on their prior authorization practices to make public the number of prior authorization requests, denials and appeals by type of medical care.

She has support from Sen. Mike Crapo (R-Idaho), who said during a recent hearing that his support for Medicare Advantage plans “does not mean that I like the prior authorization process and that I do not see some problems here that need to be solved.”

Insurer advocacy group Better Medicare Alliance told POLITICO it supports legislation and regulations to create an electronic prior authorization process that could expedite prior authorization decisions that typically take up to a week or more.

“Our goal has always been to protect prior authorization’s essential function — coordinating safe, effective, high-value care — while also strengthening and streamlining this clinical tool to better serve beneficiaries,” Mary Beth Donahue, president and CEO of the group, said in a statement.


Creighton suspects insurers would be fine with implementing guardrails for prior authorization, as long as they can continue to use it.

“It is super important that in this case one doesn’t throw out the prior authorization with the bath water,” he said. “It is just finding that balance.”

But many physicians complain that balance has tipped too far in favor of Medicare Advantage plans.

A survey released earlier this month by the physicians’ trade group Medical Group Management Association found 97 percent of medical group practices said an insurer delayed or denied medically necessary care. Another 92 percent said they had hired staff specifically to process prior authorization requests. A December 2022 survey from the American Medical Association also found that 94 percent of physicians reported care delays due to prior authorization denials or processing.

“Even when you are doing the most cost-effective treatment, you are going through the [prior authorization] process,” said Vivek Kavadi, chief radiation oncology officer for U.S. Oncology, a network of more than 1,200 physicians.

Studies show that oncology faces the most prior approval requests.

Five oncologists told POLITICO that prior authorization requests are increasing as more patients migrate from traditional Medicare to Medicare Advantage. This surge of insurer prior approval demands has put a strain on their practices’ resources, they said.

A 2020 survey of oncologists by the American Society for Radiation Oncology (ASTRO) found 64 percent reported treatment delays due to prior authorization requests increased during the pandemic.

Insurers may at times contract with radiation benefit managers, companies that manage claims processing and keep a cut of savings they generate. This can encourage more services requiring prior authorization and create a “greater incentive to identify opportunities where denials can be pushed on to the provider,” said Constantine Mantz, chief policy officer for the oncology network GenesisCare.

EviCore, a radiation benefit manager, said its work is meant to ensure patients receive care grounded in the latest clinical evidence as quickly as possible. “For requests that don’t meet evidence-based guidelines, the [physician] has the opportunity to discuss the case … which can help resolve any concerns prior to initiating a formal appeal,” the company said in a statement.

BMA did not wish to comment and AHIP declined to respond to a list of questions on radiation benefit managers.

Medicare Advantage plans have been slow to update their coverage policies and at times lag Medicare in which treatments are covered, Mantz said. This can lead to situations where a Medicare Advantage plan denies care after a prior authorization request that would be covered under traditional Medicare.


HHS’ Office of the Inspector General in a 2022 report found 13 percent out of a sample of claims from Medicare Advantage plans in which care was denied under prior authorization for services that should have been approved. Some of the examples OIG found included prior authorization denials of advanced imaging services and stays at inpatient rehabilitation facilities.

If a request is denied, a doctor can file an appeal and eventually speak with another physician to plead their case.

Recent studies have shown that most appeals to a denial get overturned. In 2021, Medicare Advantage plans fully or partially denied more than 2 million claims through prior authorization, but 82 percent of those were overturned after an appeal, according to an analysis from the think tank KFF. A 2019 survey from ASTRO found 62 percent of oncologists, who appealed on behalf of their patients, got their prior authorization denial overturned.

But doctors say getting through the appeals process can take weeks.

“It feels more like the business model is a way for insurance companies to potentially reduce costs by feeling that physicians won’t want to participate in this peer-to-peer process because it is a burden on time,” said Amar Rewari, chief of radiation oncology for the Maryland-based health system Luminis Health.



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