• Nicholas Burt, LMFT

Suit Alleges MCG and Others are Using Distorted Medical Necessity Guidelines


A recent class action filed in federal court, could have a potential impact on medical necessity guidelines for mental health residential treatment.


A Wisconsin woman filed the suit against insurer HCSC and MCG, a company which licenses coverage guidelines to insurance companies and claims administrators. The reason this has such a large potential to impact future medical necessity criteria, is that MCG is also used by eight of the largest insurers.


In the suit, the plaintiff alleges that MCG distorts accepted medical standards to minimize the importance of long-term residential treatment. She alleges that the guidelines insist that residential care should be for very short-term crisis stabilization.


The outcome of this litigation is worth keeping any eye on, as it may well have a farther-reaching impact than just HCSC and the plaintiff.


You can read more about the lawsuit here, at Cook County Record.

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