OIG OEI-09-24-00331 — MAOs Overturned Nearly All Appealed SNF Prior-Authorization Denials

95% of appealed skilled nursing facility prior-authorization denials were overturned — nearly every SNF denial that was actually appealed turned out to be wrong.ruleOIG (June 2026): MAOs Overturned Nearly All Appealed SNF Prior-Auth Denials — OEI-09-24-00331

This is one of the most recent federal audits specifically covering Medicare Advantage organizations' SNF prior-authorization practices — a companion report the same month (OEI-09-24-00330) separately found the three largest MA organizations denied inpatient rehab and long-term care hospital requests at some of the highest rates in the industry.

For a skilled nursing facility denial specifically, the real-world odds of a successful appeal are unusually high — this is one of the strongest data points for appealing rather than accepting the denial.

A 95% overturn rate on appealed cases doesn't mean 95% of ALL SNF denials are wrong — only appealed ones were measured. But it does mean that among families who took the step of appealing, the outcome was overwhelmingly in their favor.

This report specifically looked at prior-authorization denials for skilled nursing facility admission — the point at which a plan decides, before the stay even begins, whether it will cover the SNF care a physician has ordered. That's the exact decision point most of CaseWhy Appeals' own SNF guidance addresses.

It's one of two companion reports OIG published the same month examining Medicare Advantage organizations' post-acute-care denial practices — the second (OEI-09-24-00330) covered inpatient rehabilitation and long-term care hospital admissions, a related but distinct category of denial.

Read together with the 2018 and 2022 reports, this 2026 finding shows the pattern of high overturn rates on appeal hasn't gone away over nearly a decade of federal oversight attention — which is itself part of why appealing, rather than assuming the first denial is final, remains worth doing.

This report, like the others, is a public document from HHS OIG, an independent federal oversight office — its findings are audit results, not a plan's own self-reported statistics.

It's also one of the most recent entries in this body of federal oversight, meaning it reflects current Medicare Advantage practices rather than a snapshot from years ago that a plan might argue is outdated.