Medicare Audits Show Problems in Private Plans

  1. washington, oct. 6-tens of thousands of medicare recipients have been victims of deceptive sales tactics and had claims improperly denied by private insurers that run the system's huge new drug benefit program and offer other private insurance options encouraged by the bush administration, a review of scores of federal audits has found.
    paul vernon/associated press
    michael o. leavitt, the secretary of health and human services, says the medicare drug benefit is saving people money.




    the problems, described in 91 audit reports reviewed by the new york times, include the improper termination of coverage for people with h.i.v. and aids, huge backlogs of claims and complaints, and a failure to answer telephone calls from consumers, doctors and drugstores.
    medicare officials have required insurance companies of all sizes to fix the violations by adopting "corrective action plans." since march, medicare has imposed fines of more than $770,000 on 11 companies for marketing violations and failure to provide timely notice to beneficiaries about changes in costs and benefits.
    the companies include three of the largest participants in the medicare market, unitedhealth, humana and wellpoint.
    the audits document widespread violations of patients' rights and consumer protection standards. some violations could directly affect the health of patients-for example, by delaying access to urgently needed medications.
    source: http://www.nytimes.com/2007/10/07/us...re.html?ref=us accessed 10/06/2007.
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  2. 3 Comments

  3. by   elkpark
    I'm not surprised at all. These companies' first priority is to make a profit, and they'll do whatever they have to to maximize their profits (we've seen that for years with regular health insurance). On top of everything else, we, the taxpayers, are subsidizing them heavily (paying them much more per person) than it would cost for the same people to have coverage through regular Medicare, in order to make these "private Medicare" programs profitable enough to them for them to want to offer them -- part of the original design of the Part D program as written by the Republicans (when this was first proposed, none of the private insurance companies wanted to participate, because they calculated it wouldn't make them enough profit to interest them -- so the administration and congressional Republicans wrote the program so that it just gives the insurance companies enough money for each member to make it attractive for them to participate).

    It would be much more cost efficient to just provide the drug coverage through traditional Medicare, use Medicare's size and clout in the market to negotiate discounted drug prices, etc. -- but, gee, that would conflict with the GOP's commitment to supporting private business through corporate welfare, and lining the pockets of their wealthy, powerful associates in the insurance and pharmaceutical industries. The entire Part D program as it is currently set up is nothing but a big fat give-away to the insurance and drug industries.

    I understand the concerns and objections many people have to the idea of a single-payer healthcare financing system in this country, but what I can't understand is how anyone could possibly consider what we've got now (and here's another striking example!) to be better.
  4. by   TrudyRN
    No surprises here.
  5. by   woody62
    I receive Medicare Part D. And my insurance company is one of those under investigation. At the beginning of last December, I received notice that my Gold Plan was going from $63 a month, to more then $96 a month. I had a choice to make, accept the increase and get all of my medications. And take a decrease in my SSDI. Or drop to the $23 a month coverage, get some of my medications every three months and take then at a 1/4 of the recommended dose and have a few extra dollars in my pocket. I chose the $23 a month program. Four of my medications would have cost me between $30 to $60, which would have added $100 or more a month per medication to the cost. I would greatly love to see something happen to both the insurance companies and the drug companies. In fact, I would love to see something like the Canadian formulary program, happen in the the United States. But it is unlikely to happen. The two special interest groups have much more money to spend then I or many other disabled or elderly people do.

    Woody

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