Medicare Audits Show Problems in Private Plans

[cal04]

Source: NYTimes

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.

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.

Read more: http://www.nytimes.com/2007/10/07/us/07medicare.html?hp

[ProudDad]

1. Uh, anybody ready for single-payer yet???

http://www.house.gov/conyers/news_hr676_2.htm

Brief Summary of HR 676

· The United States National Health Insurance Act establishes an American national health insurance program. The bill would create a publicly financed, privately delivered health care system that uses the already existing Medicare program by expanding and improving it to all U.S. residents, and all residents living in U.S. territories. The goal of the legislation is to ensure that all Americans will have access, guaranteed by law, to the highest quality and most cost effective health care services regardless of their employment, income, or health status.
· With over 45-75 million uninsured Americans, and another 50 million who are under- insured, the time has come to change our inefficient and costly fragmented non health care system.

Who is Eligible

· Every person living in or visiting the United States and the U.S. Territories would receive a United States National Health Insurance Card and ID number once they enroll at the appropriate location. Social Security numbers may not be used when assigning ID cards.

Health Care Services Covered

· This program will cover all medically necessary services, including primary care, in patient care, outpatient care, emergency care, prescription drugs, durable medical equipment, long term care, mental health services, dentistry, eye care, chiropractic, and substance abuse treatment. Patients have their choice of physicians, providers, hospitals, clinics and practices. No co-pays or deductibles are permitted under this act.

Conversion To A Non-Profit Health Care System

· Private health insurers shall be prohibited under this act from selling coverage that duplicates the benefits of the USNHI program. Exceptions to this rule include coverage for cosmetic surgery, and other medically unnecessary treatments. Those who are displaced as the result of the transition to a non- profit health care system are the first to be hired and retrained under this act.

Cost Containment Provisions/ Reimbursement

· The National USNHI program will set reimbursement rates annually for physicians, allow for "global budgets" (annual lump sums for operating expenses) for health care providers; and negotiate prescription drug prices. The national office will provide an annual lump sum allotment to each existing Medicare region; each region will administer the program.

· The conversion to a not-for-profit health care system will take place over a 15 year period. U.S. treasury bonds will be sold to compensate investor-owned providers for the actual appraised value of converted facilities used in the delivery of care; payment will not be made for loss of business profits. Health insurance companies could be sub-contracted out to handle reimbursements.

Proposed Funding For USNHI Program:

· Maintaining current federal and state funding of existing health care programs. A modest payroll tax on all employers of 3.3%. A 5% health tax on the top 5% of income earners. A small tax on stock and bond transfers. Closing corporate tax loop-holes, repealing the Bush tax cut.

[RamboLiberal]

2. I second that - it's past time to go to single payer

K&R

[cstanleytech]

5. But would it ultimately hold up to a court challenge if passed

because you know insurance companies would be sure to file a lawsuit if it meant they might lose money because of it also I am not sure about that wording for the first line.
"Every person living in or visiting the United States and the U.S. Territories would receive a United States National Health Insurance Card and ID number once they enroll at the appropriate location. Social Security numbers may not be used when assigning ID cards."
Just wondering if it should be changed is all slightly to
"Every person legally living in or visiting the United States and the U.S. Territories would receive a United States National Health Insurance Card and ID number once they enroll at the appropriate location. Social Security numbers may not be used when assigning ID cards."
or was that part of it deeper in because I admit I did not check the link.
Oh and one other thing is there a provision that states the money from the added on tax can only be used for the program specified and not loaned, transfered or used for any other purpose?
Only reason I ask is because it annoys me when they use money like the republicans used the surplus from under clinton and it was not meant for them to use like that really.

[defendandprotect]

6. We don't owe corporations a living; though sometimes it looks like it when they mess up ---

like S&L thefts & embezzlements, Conrail/Amtrack etal ---

[defendandprotect]

7. Dems should throw out the Drug program -- and start over ---

[defendandprotect]

8. We should simply expand Medicare to cover EVERYONE . . . no insurance companies!!!!

And impeach Bush ---

[ProudDad]

26. Uh, that's HR676 (Health Care)

HR333 (cheney) and the not yet introduced bill to impeach bush.

[ProudDad]

25. NO!

Health Care is a human right.

The Civilized world, that already has Universal Single-Payer, grants health care to whomever is in their country and needs it.

That's the ONLY way to do it!

As for the money, unlike Social Security which IS an insurance policy with future pay-out, Universal Health Care would be pretty much pay as you go...the money collected would be paid out for Health Care. In the case of Universal Single-Payer about 97% of the money would go out for Health Care.

Of course, the Dems were happy to use the SS surplus to lower the "official" deficit numbers as well. After that worthless bag of skin ronny ray-gun used his war against Social Security during his campaign in '80, It was carefully explained to him how useful the "SS trust fund" was as a 'deficit lowering' device when he took over from Carter.

[Spiffarino]

17. Anybody with a heart, common sense and a calculator

...has it figured out.

The rest of America are being brainwashed by fright ads from Big Pharma and InsureCo.

Great post, by the way. :thumbsup:

[ladywnch]

3. and anyone is surprised by this HOW?!!!!! n/t

[bread_and_roses]

4. And Clinton wants to keep private insurers in "her" health care plan.....

how many examples does it take for people to understand that insurers are interested only in profit, not patients?

[Seedersandleechers]

9. Maybe she'll change her mind

if she gets elected. I suppose it's possible.

[Cleita]

11. I think she'll do what hubby Bill did. She will present a plan.

Congress won't pass it and that will be that for the rest of her Presidency.

"I tried. It got shot down. Oh, well, the people have spoken. On to other business. Now that I'm elected, I don't need to bother with it again."

[merwin]

15. WTF else can she do if Congress won't pass her plan?

The President can make recommendations to congress, but ultimately it's up to Congress to draft and pass the legislation.

That may seem foreign after 8 years of this administration, but it's the truth.

[Cleita]

19. It's foreign after eight years of Bill Clinton's administration.

He never put through another bill that Congress might have passed before it became all Repub. He just never went back. Do you think she would keep trying to get a bill they can all agree on? If she keeps pandering to big PHARMA and the health care industry it won't happen and I doubt if she will try after the first attempt. It worked once for Bill, why not Hillary?

[FreeStateDemocrat]

23. A highly improbable first term would be spent compromising positions for re-election.

Corporate whores do their master's bidding. She does not represent core Democratic values, never has, never will. The Clinton's are only interested in the quest of power not governance that would benefit the working class.

[ProudDad]

27. As do all of the others except Kucinich

I must say that I think it's more "personal" with hillary. It's kinda like the jones that bush had against Saddam.

I can conceive of Obama or Edwards being persuaded that Universal Single-Payer is the way to go and sign the bill.

I suspect that hillary's close ties to her corporate handlers (and her natural pro-corporate tendencies) wouldn't allow her to do the same. She'd probably find a reason to veto it...or even worse, muddy the waters with support for a series of "counter bills", poison pills, to continue and expand corporate welfare for the health insurance mafia and big pharma.

[Cleita]

10. I refused to sign up for it. I knew it was a racket.

Fortunately, I don't need a lot of drugs to get by.

[gratuitous]

12. So, let's see . . .

The private insurers get a guaranteed stream of income, whether they pay claims or not. What could go wrong with that?

[Name removed]

13. Deleted message

Message removed by moderator. Click here to review the message board rules.

[pattmarty]

14. Private sector efficiencies, MY ASS!!!!!!!!!!!!

[Spiffarino]

16. But it's OK!

Because Billy Tauzin loves his mama!

My mom-in-law just turned 84, and her Medicare drug benefit is an expensive pain in the ass. The bad news is her drugs cost nearly the same as did before. The good news? She got extra paperwork and a hassle!

Face it you stupid ass Republicans: You got the opportunity to test Ronnie Reagan's privatization philosophy for over 25 years and guess what...IT DOESN'T FUCKING WORK! Of course, anybody who had the common sense of a tick knew this because it didn't work in the days of the robber barons, either!

Every day I hate these people just a little bit more.

:nuke:

[Donnachaidh]

18. Add Cigna to that list of privitized assholes running medicare billing

Actually saw a bill today where they refused to pay for OXYGEN supplies -- hello????? :grr:

[lovuian]

20. can we say FREAKIN FRAUD FRAUD FRAUD

and these people are sick dying and old

Single Payer is the only way to wipe out this crap

[sutz12]

21. Surprise, surprise...

Whenever corporations start offering "lots of choices" hang on to your wallet. That is corporate code for money mining.

:shrug:

The only choice we really need is "one size fits all." Insure/cover everybody for everything. No special plans needed.

[Vinca]

22. See what happens when you serve up the populace to the private

insurance companies? Clinton, Edwards, Obama take note.

[rodeodance]

24. greed

The same insurance companies that offer stand-alone drug plans also sell Medicare Advantage plans, which provide a full range of benefits including coverage of doctor’s visits and hospital care. Enrollment in Medicare Advantage plans has grown rapidly, to more than 8 million, from 4.7 million in 2003. Federal auditors found the same types of violations in both parts of the program.

Of the audits conducted by the Department of Health and Human Services, 39 focused on drug benefits, 44 focused on managed care plans and 8 examined other types of private plans.

Medicare officials said that compliance problems occurred most often in two areas: marketing, and the handling of appeals and grievances related to the quality of care.

Many of the marketing abuses occurred in sales of the fastest-growing type of Medicare Advantage product, known as private fee-for-service plans. In June, the government announced that seven of the leading companies in this market, including UnitedHealth, Humana and Coventry, had agreed to suspend marketing of these plans. Medicare recently allowed them to resume marketing after they took steps to monitor their sales agents more closely.