MANAGED CARE: Government to Review Medicare HMO Mailings
Federal officials are "demanding that HMOs submit newsletters and other documents to the government for review before sending them to Medicare beneficiaries," the New York Times reports. The move stems from accusations from HCFA officials that insurers have been sending patients "false and/or misleading information" to encourage them to pressure Congress. The government wants the opportunity to "correct any misstatements or misleading information," prior to allowing HMOs to mail materials. But HMO lobbyists argue that the action cuts off insurer communication with patients. Karen Ignagni, president of the American Association of Health Plans, said, "We're merely imparting information to beneficiaries. They have a great deal at stake." She added, "The Clinton administration is limiting our ability to communicate with our members because it disagrees with our message." Although Dr. Robert Berenson, senior Medicare official in charge of managed care plans, acknowledged potential conflicts with HMOs' First Amendment rights, he maintained that "some restrictions were necessary because otherwise patients would receive inaccurate information, and [HCFA] would be 'unfairly blamed for benefit cuts or premium increases.'"
Federal investigators also have evidence that show HMOs have been improperly billing Medicare for some of their lobbying expenses. Regulations generally prohibit federal financing of lobbying efforts intended to influence Congress. June Gibbs Brown, inspector general at HHS, said managed care plans have charged "tens of thousands of dollars in lobbying and political activities" to Medicare. Rep. Pete Stark (D-Calf.), ranking Democrat on the Ways and Means health subcommittee, said, "HMOs should use their profits, not the money that is supposed to go to beneficiaries in medical care" to pay for their congressional lobbying activities. But HMO officials say that while some expenses may have been billed under "administrative costs," they maintain that "the practice was not forbidden by the Medicare law" (Pear, 3/19).