Horror Stories Could Cost MA, CMS Official Warns

September 30, 2007 at 04:00 PM
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The price for continued horror stories of marketing abuses in the Medicare Advantage program is that public sentiment "could easily turn" against the program, a top official of the Centers for Medicare and Medicaid warned health insurance industry officials Monday.

Kerry Weems, CMS acting administrator, made his comments at the annual Medicare & Medicaid conferences sponsored by America's Health Insurance Plans, Washington.

At the same time, Weems lauded the industry for its help in launching the Medicare Advantage and Part D prescription drug programs under Medicare.

He "especially" noted "our partnership" to establish the Medicare Part D Prescription Drug Program and the Medicare Advantage program, calling them two truly landmark benefits that have "immeasurably advanced CMS's efforts to transform our programs from passive bill-payers to actively purchasing quality and value."

But he added, "The old saying that 'a few bad apples spoil the whole bunch' is particularly apt with regard to marketing abuses."

"CMS is not the only government entity that will be stepping up oversight [of the program]," he said.

"The Congress is watching," he added. "… unless these marketing abuses are nipped in the bud, Congressional and public sentiment could easily turn against the entire MA program."

Weems announced at the meeting that the "voluntary" suspensions of seven programs for alleged marketing abuses for MA programs has been lifted.

"I'm pleased to let you know that after a rigorous review of the seven organizations, CMS has determined they now meet the multiple requirements for beneficiary protection," he said.

CMS will continue oversight of all plans, and take appropriate action if warranted.

He also said that last week, the agency imposed civil monetary penalties against two plans for marketing abuses.

"I want to be clear–despite the fact that we believe civil monetary penalties were necessary–they represent a failure for all of us … for CMS as well as these plans," Weems said. "The reality is, we should have prevented abuses, and we will need to fix them together."

He also outlined the CMS plans for open enrollment season, which starts next month.

He said the agency is "making a concerted effort" to reach people who might be eligible for the low income subsidy–those who are unaware, unsure or unable to sign up for this benefit."

In addition, CMS is making special efforts to help beneficiaries who are facing a change in their LIS status communicating with them through targeted mailings; doctors; pharmacists and other health care providers; state and local officials; community partners; and others.

He added that the agency has also made grants available to community-based organizations through the Administration on Aging's network to find and sign up low-income beneficiaries.

Moreover, he said, CMS has added new capabilities on our Web site to target this group and is mobilizing community partners nationwide.

Weems said CMS is seeking to reach three main groups of people.

These are beneficiaries who are losing their deemed status, beneficiaries who are being re-assigned, and beneficiaries who need to choose an alternative plan.

"We're doing everything we can to make sure no one in any of these groups is overlooked and everyone understands the changes they will need to make in the coming weeks," Weems said.

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