Inaccurate Information to Medicare Beneficiaries

(9/14/08)- The Department of Health and Human Services' Office of the Inspector General reported that the Medicare prescription-drug marketing materials published by private insurers don't meet federal standards for accuracy and clarity 85% of the time.

The I.G. also found that the material distributed to the beneficiaries was rarely overseen by the Centers for Medicare and Medicaid Services and did not meet the guidelines as prescribed by law.

"It's a totally unacceptable status quo when we're talking about medical benefits for American seniors," Senate Finance Chairman Max Baucus (D.-Mont.) said in a statement. "CMS has not been doing its job to regulate plans that sell Medicare benefits to seniors."

The report also found that CMS rarely used audits and on-site reviews to look at the marketing materials and instead favored reports from competing prescription-drug plans as a means of oversight.

CMS spokesman Jeff Nelligan said the agency had already implemented all of the IG's recommendations for improving oversight of prescription drug marketing material. He also asserted that the report covered CMS's 2007 review process rather than its current program.

(undated-pre-2002)-About 7 million Medicare beneficiaries are enrolled in Medicare managed care plans, versus about 32 million that are enrolled in traditional Medicare. Two recent reports from the Government Accounting Office concluded that some serious weaknesses in the system must be corrected.

The reports were made public at a hearing held by the U.S. Senate Special Committee on Aging. Chairman Chuck Grassley (R-Iowa) stated "Congress has the responsibility of making sure Medicare works". He went on to state "We have to fix what's wrong with the materials from Medicare managed care plans" All 16 managed care plans studied by the GAO had provided seniors with "inaccurate or incomplete benefit information" even though HCFA had reviewed the benefit material. All seniors should become knowledgeable as to the preventative benefits available under Medicare. Many of them are free or are available with a low co-insurance cost. See Preventive Benefits Available

Officials at the Department of Health and Human Services agreed with the report's conclusion that they should scrutinize H.M.O marketing material more closely. Almost half of the HMOs surveyed distributed materials that incorrectly described benefits and the need for referrals incorrectly. Some of the plans provided incomplete information. The report also found that "beneficiaries frequently received incomplete notices that failed to explain their appeal rights." Some of the H.M.Os failed to inform the members of the right to appeal at all.

Medicare officials review and approve all booklets and marketing materials sent to Medicare beneficiaries by the H.M.O. Even if there are mistakes in the material Medicare officials were found to be deficient in having a follow-up procedure to make sure that the mistakes were corrected. The report also stated that there is no single document to fully describe the services covered by the Medicare H.M.O. Usually there are 4 or 5 documents to be read, and frequently one document will contradict the other.

Please be aware that starting in January 2002 that you will no longer be allowed to quit an H.M.O. upon one month's notice. You will be able to change your decision only once a year outside Medicare's annual open enrollment period.


by Allan Rubin
updated September 14, 2008

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