Medicare Health Care Audits Find Consumer Rights Violations

Federal health care audits have found widespread violations of patients’ rights and consumer protection standards owing to private health insurers who use deceptive sales tactics, aggressively prey on the elderly and disabled, and deny legitimate health claims, according to the New York Times.

Tens of thousands of Medicare Advantage health consumers have been left without appropriate medical care, including urgently needed medications, while being forced to deal with companies that fail to answer telephone calls and have staggering backlogs of claims and complaints.

Medicare officials have so far imposed more than $770,000 in fines on private insurers for marketing violations and failure to provide timely notice to beneficiaries about changes in costs and benefits. The companies have also been ordered to implement “corrective action plans”.

In one case, Medicare terminated its contract with a Florida-based private plan after finding that it posed an “imminent and serious threat” to 11,000 health consumers.

A total of 91 audits were conducted by the Department of Health and Human Services – 39 dealt with drug benefits, 44 focused on managed care plans and 8 examined other types of private health care plans.

Marketing violations topped the list of private sector abuses, along with failure to provide timely notice to beneficiaries about changes in costs and benefits.

Representative Bart Stupak (D-Mich.), who chairs the investigations subcommittee of the House Energy and Commerce Committee, confirmed that he had “verified countless stories of deceptive sales practices by insurance agents who prey upon the elderly and disabled to sell them expensive and inappropriate private Medicare plans.”

Violations were committed by scores of companies including UnitedHealth, Humana and WellPoint – three major participants in the Medicare program.

UnitedHealth lacked an effective program to supervise its marketing representatives, agents and brokers and, in a number of cases, the company had rejected claims without explanation. Marketing abuses by UnitedHealth and Humana led to suspensions of their marketing Medicare Advantage private fee-for-service plans – which they were allowed to resume after implementing measures to monitor their sales agents more closely. WellPoint, a company with a backlog of about 354,000 claims, took nearly half an hour to answer phone calls from its members; most callers hung up before speaking to a company representative.

Medicare officials have warned companies that they will need to correct “demonstrated patterns of failure” if they want to continue to participate in the Medicare program.

A key focus for Medicare will be the burgeoning number of abuses relating to deceptive marketing tactics.

“The start-up period is over,” said Kerry Weems, acting administrator of the Centers for Medicare and Medicaid Services. “I am simply not going to tolerate marketing abuses.”

Kathleen Healey, a lawyer at the Alabama Department of Senior Services, told the New York Times: “Despite the prohibition of door-to-door marketing, agents arrive on residents’ doorsteps stating that the president sent them, or that they represent Medicare. Some telemarketers insist they are calling from Medicare, and they tell beneficiaries that they will lose their Medicare if they do not sign up for the telemarketer’s plan.”

David Lipschutz, a lawyer for the non-profit group California Health Advocates, said generous payments for companies who sign up Medicare recipients would continue to encourage predatory sales practices.

“Every enrollee in a private Medicare plan is a potential source of substantial profits,” he said.

Source: The New York Times


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