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Medicare News
Medicare Advantage Marketing Tactics Get Scrutiny of
Senate Aging Committee
Chairman Kohl notes some plans have announced
reforms
 May 16, 2007 – Amidst growing concern about the
aggressive marketing tactics of Medicare Advantage plans, the Senate
Select Committee on Aging held a hearing today that shed new light on
the problem from the point of view of the senior citizen consumer, the
Centers for Medicare and Medicaid and the insurance companies.
Chairman Herb Kohl (D-WI) noted in an opening
statement, “In the last week, some Medicare Advantage plans announced
initiatives to reform their marketing and sales practice guidelines.”
He said the focus of the hearing was “with the
numerous and widespread complaints involving the sales and marketing of
Medicare Advantage plans which are being aggressively promoted around
the country.
“For those of you not familiar with Medicare
Advantage plans, they are private plan options, ranging from managed
care to private fee for service plans, which are offered to Medicare
beneficiaries as an alternative to traditional Medicare. While they have
been in existence for some time, Medicare Advantage plans are now the
fastest growing segment of the Medicare world and are an increasingly
profitable enterprise for many plan sponsors.
“Unfortunately, wide-spread confusion—and in some
cases outright misrepresentation and fraud—have been associated with the
sale of these plans. Complaints appear to be nationwide, and a troubling
pattern has emerged.”
Sen. Kohl said, “Our investigation has revealed a
disturbingly consistent picture, one which only seems to be growing.
Countless seniors purchasing Medicare Advantage plans have been preyed
upon and unwittingly taken advantage of by insurance agents.
“Seniors have been removed from traditional
Medicare without their knowledge, signed onto plans they can’t afford,
misled regarding coverage, and told their doctors accept these plans,
when in reality they don’t. This is simply unacceptable.
“One of the most troubling problems we have seen
involves insurance agents misrepresenting and marketing Medicare
Advantage plans in inappropriate manners and places, such as within
nursing homes.
“We are not suggesting today that CMS has done
nothing to address these problems—or that CMS officials are unconcerned
about them. According to some state officials, CMS regional offices have
made legitimate efforts to lend a hand, as they should, particularly
when fraud and confusion have left our seniors with health insurance
gaps and unnecessary additional costs.
“Nevertheless, it is clear that a major disconnect
in oversight exists--one which needs to be addressed immediately.”
Below is a list of presenters at the hearing,
“Medicare Advantage Marketing & Sales: Who Has The Advantage?” Each
presenters testimony is available by clicking on their name.
Senator Herb Kohl
(D-WI), Chairman
Witness Testimony
Abby Block,
Director, Center for Beneficiary Choices, Centers for Medicare and
Medicaid, Baltimore, Maryland
Commissioner Sean
Dilweg, Wisconsin Office of the Commissioner of Insurance,
Madison, Wisconsin
Commissioner Kim
Holland, Oklahoma Insurance Department, Oklahoma City,
Oklahoma
Special Agent
Sherry Mowell, Georgia Office of the Commissioners of
Insurance, Atlanta, Georgia
Albert Sochor,
Vice President and Director of Marketing, Old Surety Life Insurance,
Oklahoma City, Oklahoma
Karen Ignagni,
President and CEO, America's Health Insurance Plans, Washington, DC
Heidi Margulis,
Senior Vice President, Humana Inc., Lousiville, Kentucky
Peter J. Clarkson,
Senior Vice President, Distributions Operations, UnitedHealth Group,
Minnetonka, Minnesota
Gary Bailey,
Vice President, Medicare Operational Performance, WellCare, Tampa,
Florida
>> ›
Click here to view
Webcast.
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Following is a report released before the hearing
in the Daily Report from KaiserNet.org |
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Senate Special Committee on Aging to Address
Aggressive Sales Tactics Used for Medicare Advantage Plans
The
Senate Special
Committee on Aging on Wednesday plans to hold a hearing to
address unethical or illegal
practices
that some sales agents reportedly have used to enroll Medicare
beneficiaries in private Medicare Advantage plans, the
San Francisco
Chronicle reports (Colliver, San Francisco Chronicle, 5/16).
In advance of the hearing, Senate investigators
released to Congress interviews and documents that indicate sales agents
in at least 39 states have used unethical or illegal practices. Such
practices have included the enrollment of dead or mentally incompetent
Medicare beneficiaries, the impersonation of Medicare representatives
and the use of personal information stolen from federal records,
according to Senate investigators.
In addition, Senate investigators "have found that
improper sales practices inspired by insurers offering high commissions
have drawn civil and criminal cases, damaging the credibility of a
program that some have called a model for revamping the Medicare
system," the Washington Post reports.
Comments
Leslie Norwalk -- acting administrator of
CMS,
which last week decided to require private Medicare fee-for-service
plans to call beneficiaries prior to enrollment to ensure that they
understand the plans and have decided to enroll in them -- said that any
program as large as Medicare will attract fraud. Norwalk also said that
CMS allows Medicare beneficiaries to leave plans in which they enrolled
because of unethical or illegal practices by sales agents and penalizes
health insurers involved with the practices with fines, suspensions of
enrollment or revocation of the ability to sell fee-for-service plans.
Senate Special Committee on Aging Chair Herb Kohl
(D-Wis.) said, "There's a lamentable lack of oversight when it comes to
the sales practices being used to sell Medicare Advantage plans to our
seniors." Kohl added, "Our goal is that these plans must be represented
in a transparent, honest and fair way."
Karen Ignagni, president of
America's Health
Insurance Plans, said, "We're going to be talking about zero
tolerance" at the hearing. Ignagni said that proposals include new
qualifications and training for sales agents, in addition to increased
protections to ensure that Medicare beneficiaries understand the plans
in which they enroll (Williamson/Lee, Washington Post, 5/16).
Robert Hayes, president of the
Medicare Rights
Center, said, "It's time the administration paid attention to
this. We're swamped with people reporting abuse, fraud and
misrepresentation." Hayes added, "It's a Wild West market" (San
Francisco Chronicle, 5/16).
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