Medicare Customer Service Guidelines Not Enforced
The Bush administration is "having difficulty regulating" drug plans under the Medicare prescription drug benefit "to ensure they comply with federal standards" for customer service, consumer protection and marketing, the New York Times reports. According to the Times, administration officials "are juggling two potentially incompatible roles as they try to police the new program while defending it against a barrage of election-year criticism from Democrats."
Federal officials say many of the insurers who sponsor Medicare drug plans have referred beneficiaries to the Medicare help line when they call with complaints, instead of providing help themselves.
Cynthia Tudor, a senior Medicare official, said in a recent memorandum to insurers that the government "has been receiving a large number of urgent requests from beneficiaries who are enrolled" in drug plans. She added, "These urgent requests generally mean that the beneficiary is in immediate need of a medication refill."
In addition, Tudor has twice in the last month sent a reminder to insurers of their "obligation to resolve complaints" from beneficiaries enrolled in their plans, noting that the Medicare help line "is not intended to respond to complaints or questions enrollees have about their particular Part D plan."
Meanwhile, data from drug plans on customer service -- which the federal government says could help consumers choose a drug plan -- have not yet been released, the Times reports. In addition, state officials say the federal government is not doing enough to enforce marketing guidelines for drug plans.
According to the Times, "Insurers say the government is responsible for some of the problems that have provoked the most complaints from beneficiaries," including problems related to automatic deductions of premiums from Social Security checks. Further, "Insurers have repeatedly asked the administration to clarify what is required and what is simply recommended," the Times reports.
John Gorman, a former Medicare official who is now a consultant for insurers, said, "The government has given companies an unofficial grace period in the first year [of the drug benefit], while they try to make this program work." He added, "We do not expect to see much enforcement unless there's an egregious violation."
Judith Stein, director of the Center for Medicare Advocacy, said, "Most of the guidelines are phrased as recommendations or suggestions, not binding requirements, so they are difficult to enforce."
Karen Ignagni, president and CEO of America's Health Insurance Plans, said the administration created "a new regulatory model" for the drug benefit, adding, "It's a very productive partnership."
CMS Administrator Mark McClellan said his agency is monitoring plans' compliance with federal guidelines and will "take action when appropriate." CMS will consider each plan's compliance when deciding whether to renew its contracts for next year, and the agency has the authority to terminate contracts this year for any plans that are "substantially out of compliance," he said (Pear, New York Times, 6/25).