MEDICARE HMOS: Analysis Finds Widespread Violations
A new report from the Medicare Rights Center raises serious questions about Medicare HMOs and their compliance with rules designed to protect seniors, the Wall Street Journal reports. According to a draft of a report to be released next week, an analysis of 179 complaints made to the Medicare Rights Center over a six month period found that in nearly half the cases the plans were in violation of Medicare rules governing "premature termination of home care, denial of coverage for emergency care and slow or improper handling of appeals and requests for approval of medical services." Approximately 6 million seniors and disabled beneficiaries belong to Medicare HMO plans. Joe Baker, associate director of the Medicare Rights Center, charged that consumer-protection rules are useless without enforcement. "You can have all the good rules on the books, but we need enforcement and monitoring to make sure HMOs are living up to the guidelines," he said. Responding to the report's findings, Susan Pisano, spokesperson for the American Association of Health Plans, said, "There are always instances when things are less than perfect," but she added that "HMOs are working well for patients most of the time." The Health Care Financing Administration declined to comment on the report, but said "16 Medicare HMOs are implementing corrective-action plans required by the HCFA to address problems involving appeals, quality assurance and other issues."
How To Get Results
In separate news, the National Association of Insurance Commissioners has released "a new consumer kit on resolving health insurance disputes." The kit is available at www.naic.org, or call NAIC at 816/842-3600 (Jeffrey, 9/10).